Healthcare Provider Details

I. General information

NPI: 1013022615
Provider Name (Legal Business Name): ALBORZ HASSANKHANI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5525 GROSSMONT CENTER DR STE 609
LA MESA CA
91942-3009
US

IV. Provider business mailing address

PO BOX 2187
LA MESA CA
91943-2187
US

V. Phone/Fax

Practice location:
  • Phone: 619-668-0044
  • Fax: 619-245-2481
Mailing address:
  • Phone: 619-668-0044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberA71799
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: