Raiszadeh, Mahindokht Mary

Raiszadeh, Mahindokht Mary is an sole proprietor health care provider with primary practice located at 5222 Balboa Ave Ste 45, San Diego CA 92117-6904. She recently has only one registered license in Other Service Providers / Legal Medicine, which is considered as her primary health care specialty. Raiszadeh, Mahindokht Mary can be contacted via phone (858) 616-6430.

Contact Information

Primary practice address
5222 Balboa Ave Ste 45 San Diego CA 92117-6904
Phone: (858) 616-6430
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Legal Medicine 173000000X A34656 California

Profile Details

NPI number 1194898064
LBN Legal business name Raiszadeh, Mahindokht Mary
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 16th, 2006
Last updated Nov 5th, 2012 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1194898064 NPPES
California MEDICAID 00A346561

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