=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841901816
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SIAVOSHI, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2022
-----------------------------------------------------
Last Update Date | 12/09/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 553 TORRANCE ST
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92103-4096
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-326-9291
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 553 TORRANCE ST
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92103-4096
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-326-9291
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NEUROLOGIST
-----------------------------------------------------
Name | SARA SIAVOSHI
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 714-326-9291
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------