Healthcare Provider Details

I. General information

NPI: 1932737186
Provider Name (Legal Business Name): AMELINDA MARTHA ZAVARO-KHANJIAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5525 GROSSMONT CENTER DR
LA MESA CA
91942-3009
US

IV. Provider business mailing address

1994 VIA CASA ALTA
LA JOLLA CA
92037-5730
US

V. Phone/Fax

Practice location:
  • Phone: 602-246-5525
  • Fax:
Mailing address:
  • Phone: 619-857-4255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A21499
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: