Healthcare Provider Details

I. General information

NPI: 1104936426
Provider Name (Legal Business Name): MAHJABEEN KAMYAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 02/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 JAMACHA RD STE 203
EL CAJON CA
92019-3224
US

IV. Provider business mailing address

860 JAMACHA RD STE 203
EL CAJON CA
92019-3224
US

V. Phone/Fax

Practice location:
  • Phone: 619-442-0945
  • Fax: 619-579-5945
Mailing address:
  • Phone: 619-442-0945
  • Fax: 619-579-5945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC40228
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: