MEDICARE: DR. HOSSEIN M EBNESHAHIDI 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	207Q00000X	Family Medicine Physician	A107313	CA

General Provider Information

NPI Number	:	1265661953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HOSSEIN M EBNESHAHIDI M.D.

Provider Business Mailing Address
First Line	:	PO BOX 4195
Second Line	:
City	:	CERRITOS
State	:	CA
Zip	:	90703-4195
Country	:	US
Telephone Number	:	818-523-7684
Fax Number	:

Provider Business Practice Location Address
First Line	:	1590 S IMPERIAL AVE
Second Line	:
City	:	EL CENTRO
State	:	CA
Zip	:	92243-4241
Country	:	US
Telephone Number	:	760-970-8906
Fax Number	:	760-970-4070

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

Provider Enumeration Date	:	07/02/2009
Last Update Date	:	12/04/2023

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