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General NPI Number Information
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NPI Number | 1225188089
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Entity Type | Individual
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Provider Name | BAHRAM BAHRAMI
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Gender | Male
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 11/18/2015
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Provider Practice Location Address
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Address Line | 2934 INGELOW ST
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City | SAN DIEGO
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State | CA
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Zip | 92106-2311
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Country | US
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Telephone | 760-480-4310
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Fax | 760-480-4350
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Provider Business Mailing Address
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Address Line | 777 BANGOR ST
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City | SAN DIEGO
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State | CA
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Zip | 92106-2951
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Country | US
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Telephone | 619-857-0063
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Fax | 760-480-4350
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A-23638
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License Number State | CA
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