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General NPI Number Information
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NPI Number | 1528083474
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Entity Type | Organization
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Legal Business Name | BANAIE MEDICAL CORPORATION
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 11/10/2021
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Provider Practice Location Address
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Address Line | 8860 CENTER DRIVE SUITE 420
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City | LA MESA
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State | CA
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Zip | 91942-3020
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Country | US
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Telephone | 619-469-5400
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Fax | 619-464-1311
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Provider Business Mailing Address
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Address Line | 8860 CENTER DRIVE SUITE 420
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City | LA MESA
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State | CA
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Zip | 91942-3020
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Country | US
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Telephone | 619-469-5400
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Fax | 619-464-1311
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | ALI BANAIE
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Credential | M.D.
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Telephone | 619-469-5400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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