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General NPI Number Information
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NPI Number | 1356796130
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Entity Type | Organization
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Legal Business Name | SHAW S ESLAMIAN MD PC
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Dates
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Enumeration Date | 04/28/2016
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Last Update Date | 04/28/2016
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Provider Practice Location Address
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Address Line | 1140 WALL ST SUITE 1013
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City | LA JOLLA
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State | CA
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Zip | 92038-7001
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Country | US
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Telephone | 858-692-6535
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Fax | 810-454-5951
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Provider Business Mailing Address
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Address Line | 5555 GROSSMONT CENTER DR
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City | LA MESA
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State | CA
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Zip | 91942-3019
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Country | US
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Telephone | 858-692-6535
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Fax | 810-454-5951
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHAW S. ESLAMIAN
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Credential | MD
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Telephone | 858-692-6535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A101252
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License Number State | CA
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