Healthcare Provider Details

I. General information

NPI: 1386033371
Provider Name (Legal Business Name): ENCOMPASS PRIVATE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2015
Last Update Date: 01/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7051 ALVARADO RD SUITE 101
LA MESA CA
91942-8901
US

IV. Provider business mailing address

7051 ALVARADO RD SUITE 101
LA MESA CA
91942-8901
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT LAJVARDI
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 619-460-7777