Healthcare Provider Details

I. General information

NPI: 1528340437
Provider Name (Legal Business Name): SAMETI-BIRDJANDI MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2011
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6719 ALVARADO RD SUITE 100
SAN DIEGO CA
92120-5270
US

IV. Provider business mailing address

PO BOX 34120
RENO NV
89533-4120
US

V. Phone/Fax

Practice location:
  • Phone: 858-495-0971
  • Fax: 858-495-0991
Mailing address:
  • Phone: 877-747-5050
  • Fax: 877-747-5005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License NumberC54511
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA89932
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MAHNAZ SAMETI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 858-495-0971