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General NPI Number Information
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NPI Number | 1972704054
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Entity Type | Organization
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Legal Business Name | ANOUSHIRAVAN BOGHAIRI MD
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5565 GROSSMONT CENTER DRIVE BLDG 1 STE 115
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City | LA MESA
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State | CA
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Zip | 91942
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Country | US
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Telephone | 619-698-6667
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Fax | 619-698-6684
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Provider Business Mailing Address
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Address Line | 5565 GROSSMONT CENTER DRIVE BLDG 1 STE 115
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City | LA MESA
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State | CA
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Zip | 91942
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Country | US
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Telephone | 619-698-6667
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Fax | 619-698-6684
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANOUSHIRAVAN BOGHAIRI
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Credential | MD
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Telephone | 619-698-6667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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