Healthcare Provider Details

I. General information

NPI: 1588918544
Provider Name (Legal Business Name): BIRDJANDI MD.INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2012
Last Update Date: 10/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5313 RENAISSANCE AVE #2
SAN DIEGO CA
92122-5634
US

IV. Provider business mailing address

5313 RENAISSANCE AVE #2
SAN DIEGO CA
92122-5634
US

V. Phone/Fax

Practice location:
  • Phone: 203-461-1963
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA89932
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberA89932
License Number StateCA

VIII. Authorized Official

Name: FARSCHAD BIRDJANDI
Title or Position: MD
Credential:
Phone: 203-461-1962