Healthcare Provider Details

I. General information

NPI: 1497146120
Provider Name (Legal Business Name): AYDA DASHTAEI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2015
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15611 POMERADO RD STE 400
POWAY CA
92064-2437
US

IV. Provider business mailing address

3048 STARRY NIGHT DR
ESCONDIDO CA
92029-4841
US

V. Phone/Fax

Practice location:
  • Phone: 760-300-3647
  • Fax: 858-207-0034
Mailing address:
  • Phone: 858-207-8569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number20A18093
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: