Healthcare Provider Details

I. General information

NPI: 1740467224
Provider Name (Legal Business Name): SHAW SHAHRIAR ESLAMIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2008
Last Update Date: 08/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5906 RUTGERS RD
LA JOLLA CA
92037-7833
US

IV. Provider business mailing address

PO BOX 13523
LA JOLLA CA
92039-3523
US

V. Phone/Fax

Practice location:
  • Phone: 858-692-6535
  • Fax:
Mailing address:
  • Phone: 858-692-6535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA101252
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: