Healthcare Provider Details

I. General information

NPI: 1528320876
Provider Name (Legal Business Name): ANAHITA DASHTAEI PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 01/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1884 VILLA DEL DIOS GLN
ESCONDIDO CA
92029-5320
US

IV. Provider business mailing address

8695 SPECTRUM CENTER CT
SAN DIEGO CA
92123-1489
US

V. Phone/Fax

Practice location:
  • Phone: 858-610-4471
  • Fax:
Mailing address:
  • Phone: 858-610-4471
  • Fax: 858-636-2073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number64067
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: