Healthcare Provider Details

I. General information

NPI: 1437614310
Provider Name (Legal Business Name): MEDI ESLANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2019
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 THIRD AVE STE A
CHULA VISTA CA
91911-1352
US

IV. Provider business mailing address

835 THIRD AVE STE A
CHULA VISTA CA
91911-1352
US

V. Phone/Fax

Practice location:
  • Phone: 619-425-7755
  • Fax: 619-425-2138
Mailing address:
  • Phone: 619-425-7755
  • Fax: 619-425-2138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA182546
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License NumberA182546
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: