Healthcare Provider Details

I. General information

NPI: 1437174349
Provider Name (Legal Business Name): BEHZAD BANIADAM MD APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3231 WARING CT STE L
OCEANSIDE CA
92056-4510
US

IV. Provider business mailing address

1618 BURGUNDY RD
ENCINITAS CA
92024-1207
US

V. Phone/Fax

Practice location:
  • Phone: 760-630-6300
  • Fax: 760-630-1100
Mailing address:
  • Phone: 760-630-6300
  • Fax: 760-630-1100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberFNP31640
License Number StateCA

VIII. Authorized Official

Name: DR. BEHZAD BANIADAM
Title or Position: PRES.
Credential: M.D.
Phone: 760-630-6300