Healthcare Provider Details

I. General information

NPI: 1548767726
Provider Name (Legal Business Name): ANDYSHEH KAMGAR-PARSI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 W 2ND AVE
ESCONDIDO CA
92025-3839
US

IV. Provider business mailing address

PO BOX 7410882
CHICAGO IL
60674-0882
US

V. Phone/Fax

Practice location:
  • Phone: 872-231-3162
  • Fax:
Mailing address:
  • Phone: 702-899-0595
  • Fax: 702-977-1496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number20A17680
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: