Healthcare Provider Details

I. General information

NPI: 1528057957
Provider Name (Legal Business Name): ROKAY KAMYAR, M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5119 GARFIELD ST
LA MESA CA
91941-5103
US

IV. Provider business mailing address

5119 GARFIELD ST
LA MESA CA
91941-5103
US

V. Phone/Fax

Practice location:
  • Phone: 619-460-4055
  • Fax: 619-460-5148
Mailing address:
  • Phone: 619-460-4055
  • Fax: 619-460-5148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. KATHERINE HENDRICKSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 619-460-4055