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NPI Code Detail

MEDICARE: DR. MARYAM AFSHAR M.D.

MEDICARE: DR. MARYAM 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
1390200000XStudent in an Organized Health Care Education/Training Program
2207N00000XDermatology PhysicianA132453CA

General Provider Information

NPI Number : 1992063036
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARYAM AFSHAR M.D.
Provider Business Mailing Address
First Line : PO BOX 504048
Second Line :
City : SAN DIEGO
State : CA
Zip : 92150-4048
Country : US
Telephone Number : 760-758-5340
Fax Number : 760-758-5502
Provider Business Practice Location Address
First Line : 8899 UNIVERSITY CENTER LN STE 350
Second Line :
City : SAN DIEGO
State : CA
Zip : 92122-1010
Country : US
Telephone Number : 858-657-8322
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2012
Last Update Date : 10/01/2019

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