Healthcare Provider Details

I. General information

NPI: 1255561122
Provider Name (Legal Business Name): BAHAR RAHNAMAYI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2009
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 GENESEE AVE STE 320
LA JOLLA CA
92037-1208
US

IV. Provider business mailing address

9850 GENESEE AVE STE 320
LA JOLLA CA
92037-1208
US

V. Phone/Fax

Practice location:
  • Phone: 858-692-0098
  • Fax: 858-795-1195
Mailing address:
  • Phone: 858-692-0098
  • Fax: 858-795-1195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA113410
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: