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NPI Code Detail

MEDICARE: DIBA MORTAZAVI DO

MEDICARE: DIBA MORTAZAVI DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1831037753
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIBA MORTAZAVI DO
Provider Business Mailing Address
First Line : 10380 SPRING CANYON RD UNIT 442
Second Line :
City : SAN DIEGO
State : CA
Zip : 92131-3877
Country : US
Telephone Number : 916-458-2324
Fax Number :
Provider Business Practice Location Address
First Line : 930 CHESTNUT RIDGE RD
Second Line :
City : MORGANTOWN
State : WV
Zip : 26505-2807
Country : US
Telephone Number : 304-293-5323
Fax Number : 304-293-8724
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2026
Last Update Date : 03/23/2026

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Directions to “ DIBA MORTAZAVI DO” Practice Location

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