Healthcare Provider Details

I. General information

NPI: 1801484241
Provider Name (Legal Business Name): MASOUD AFSHAR MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2020
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 N IMPERIAL AVE
IMPERIAL CA
92251-1265
US

IV. Provider business mailing address

220 N IMPERIAL AVE
IMPERIAL CA
92251-1265
US

V. Phone/Fax

Practice location:
  • Phone: 442-283-5049
  • Fax: 760-344-7106
Mailing address:
  • Phone: 442-283-5049
  • Fax: 760-344-7106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MASOUD AFSHAR
Title or Position: PRESIDENT
Credential: MD
Phone: 442-283-5049