MEDICARE: CYRUS DAMIRCHI 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	A50298	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891883401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYRUS DAMIRCHI M.D.

Provider Business Mailing Address
First Line	:	355 E 21ST ST STE F
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92404-4851
Country	:	US
Telephone Number	:	909-886-5251
Fax Number	:	949-631-1798

Provider Business Practice Location Address
First Line	:	355 E 21ST ST STE F
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92404-4851
Country	:	US
Telephone Number	:	909-886-5251
Fax Number	:	949-631-1798

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	05/09/2013

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