Healthcare Provider Details

I. General information

NPI: 1053683797
Provider Name (Legal Business Name): S&I CAPITAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2012
Last Update Date: 01/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 COAST BLVD UNIT 18E
LA JOLLA CA
92037-4149
US

IV. Provider business mailing address

939 COAST BLVD UNIT 19D
LA JOLLA CA
92037-4169
US

V. Phone/Fax

Practice location:
  • Phone: 858-354-4640
  • Fax:
Mailing address:
  • Phone: 858-354-4640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA51498
License Number StateCA

VIII. Authorized Official

Name: DR. SEAN K TAYEBI
Title or Position: MD
Credential: FACOG
Phone: 858-354-4640