Healthcare Provider Details

I. General information

NPI: 1003088832
Provider Name (Legal Business Name): SOLMAZ MODEER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 FOURTH AVE STE 300
CHULA VISTA CA
91910-4429
US

IV. Provider business mailing address

PO BOX 504447
SAN DIEGO CA
92150-4447
US

V. Phone/Fax

Practice location:
  • Phone: 619-409-6939
  • Fax: 619-409-6949
Mailing address:
  • Phone: 858-733-8997
  • Fax: 619-409-6949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2471M2300X
TaxonomyMammography Radiologic Technologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberTG145
License Number StateCA

VIII. Authorized Official

Name: SOLMAZ MODEER
Title or Position: OWNER/DIRECTOR
Credential: ARRT(M)(F)(R)
Phone: 619-409-6939