Healthcare Provider Details

I. General information

NPI: 1326158601
Provider Name (Legal Business Name): EL CAJON PEDIATRIC MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 08/22/2020
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 Number
License Number State

VIII. Authorized Official

Name: DR. MAHJABEEN KAMYAR
Title or Position: PRESIDENT
Credential: MD
Phone: 619-442-0945