Healthcare Provider Details

I. General information

NPI: 1881338317
Provider Name (Legal Business Name): YASAMIN DANESHVAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2022
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5565 GROSSMONT CENTER DR
LA MESA CA
91942-3020
US

IV. Provider business mailing address

PO BOX 34869
BELFAST ME
04915-0626
US

V. Phone/Fax

Practice location:
  • Phone: 619-295-9494
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE6114
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: