Healthcare Provider Details

I. General information

NPI: 1265628309
Provider Name (Legal Business Name): FAMILY ALLERGY, ASTHMA, IMMUNOLOGY & SINUS CENTER P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 07/21/2020
Certification Date: 07/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15725 POMERADO RD STE 218
POWAY CA
92064-2060
US

IV. Provider business mailing address

15725 POMERADO RD STE 218
POWAY CA
92064-2060
US

V. Phone/Fax

Practice location:
  • Phone: 858-521-0806
  • Fax: 858-521-0808
Mailing address:
  • Phone: 858-521-0806
  • Fax: 858-521-0808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberA63974
License Number StateCA

VIII. Authorized Official

Name: DR. MARYAM ZAREI
Title or Position: OWNER
Credential: MD
Phone: 858-521-0806