Healthcare Provider Details

I. General information

NPI: 1538063375
Provider Name (Legal Business Name): TAHER SATHALIYA MBBS, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3725 30TH ST
SAN DIEGO CA
92104-3607
US

IV. Provider business mailing address

3725 30TH ST
SAN DIEGO CA
92104-3607
US

V. Phone/Fax

Practice location:
  • Phone: 619-666-5240
  • Fax:
Mailing address:
  • Phone: 619-666-5240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: