Healthcare Provider Details

I. General information

NPI: 1730356106
Provider Name (Legal Business Name): BAHAR MADANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10666 N TORREY PINES RD
LA JOLLA CA
92037-1027
US

IV. Provider business mailing address

10170 SORRENTO VALLEY RD PAVILLION III, SUITE #268
SAN DIEGO CA
92121-1604
US

V. Phone/Fax

Practice location:
  • Phone: 858-554-4310
  • Fax:
Mailing address:
  • Phone: 858-784-5888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number101882
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number101882
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License NumberN5211
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: