Healthcare Provider Details

I. General information

NPI: 1841356664
Provider Name (Legal Business Name): KAMSHAD RAISZADEH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7525 METROPOLITAN DR STE 306
SAN DIEGO CA
92108-4404
US

IV. Provider business mailing address

7525 METROPOLITAN DR STE 306
SAN DIEGO CA
92108-4404
US

V. Phone/Fax

Practice location:
  • Phone: 619-275-7460
  • Fax: 866-813-1235
Mailing address:
  • Phone: 619-275-7460
  • Fax: 866-813-1235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberG74016
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: