MEDICARE: POUYA AFSHAR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	A107069	CA

General Provider Information

NPI Number	:	1184958977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	POUYA AFSHAR M.D.

Provider Business Mailing Address
First Line	:	7801 MISSION CENTER CT STE 310
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-1316
Country	:	US
Telephone Number	:	619-795-8346
Fax Number	:

Provider Business Practice Location Address
First Line	:	7801 MISSION CENTER CT STE 310
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-1316
Country	:	US
Telephone Number	:	619-795-8346
Fax Number	:	619-831-8346

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2009
Last Update Date	:	09/19/2022

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