Healthcare Provider Details

I. General information

NPI: 1427136332
Provider Name (Legal Business Name): HOSSEIN TABRIZIANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 04/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8010 FROST ST STE 510
SAN DIEGO CA
92123-4284
US

IV. Provider business mailing address

9610 GRANITE RIDGE DR STE B
SAN DIEGO CA
92123-2684
US

V. Phone/Fax

Practice location:
  • Phone: 858-637-4700
  • Fax: 858-637-4701
Mailing address:
  • Phone: 858-810-8000
  • Fax: 858-346-1024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA78291
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA78291
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD038954
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: