Healthcare Provider Details

I. General information

NPI: 1427456151
Provider Name (Legal Business Name): SIAVOSH VAKILIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2014
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3366 5TH AVE
SAN DIEGO CA
92103-5713
US

IV. Provider business mailing address

PO BOX 845996
LOS ANGELES CA
90084-3592
US

V. Phone/Fax

Practice location:
  • Phone: 619-230-0400
  • Fax: 858-429-7936
Mailing address:
  • Phone: 858-888-7700
  • Fax: 858-221-5036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberA133482
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: