Healthcare Provider Details

I. General information

NPI: 1851650584
Provider Name (Legal Business Name): PEGAH MARYAM MASHAYEKHI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2012
Last Update Date: 03/03/2025
Certification Date: 03/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12395 EL CAMINO REAL STE 209
SAN DIEGO CA
92130-3084
US

IV. Provider business mailing address

12395 EL CAMINO REAL SUITE 209
SAN DIEGO CA
92130
US

V. Phone/Fax

Practice location:
  • Phone: 858-224-1866
  • Fax: 858-207-5042
Mailing address:
  • Phone: 858-224-1866
  • Fax: 858-207-5042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number20A12987
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A12987
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number20A12987
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: