Healthcare Provider Details

I. General information

NPI: 1033449640
Provider Name (Legal Business Name): ENCOMPASS FAMILY AND INTERNAL MEDICINE GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2010
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7051 ALVARADO RD 201
LA MESA CA
91942-8901
US

IV. Provider business mailing address

7051 ALVARADO RD 201
LA MESA CA
91942-8901
US

V. Phone/Fax

Practice location:
  • Phone: 619-460-7775
  • Fax: 858-519-5446
Mailing address:
  • Phone: 619-460-7775
  • Fax: 619-460-7023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberA89608
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA89608
License Number StateCA

VIII. Authorized Official

Name: DR. ROBERT BEROOZ LAJVARDI
Title or Position: OWNER
Credential: M.D.
Phone: 619-460-7775