Provider Demographics
NPI:1013022615
Name:HASSANKHANI, ALBORZ
Entity Type:Individual
Prefix:
First Name:ALBORZ
Middle Name:
Last Name:HASSANKHANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2187
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91943-2187
Mailing Address - Country:US
Mailing Address - Phone:619-668-0044
Mailing Address - Fax:
Practice Address - Street 1:5525 GROSSMONT CENTER DR STE 609
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3009
Practice Address - Country:US
Practice Address - Phone:619-668-0044
Practice Address - Fax:619-245-2481
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71799207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A717990Medicaid
I04699Medicare UPIN
CA00A717990Medicaid