Provider Demographics
NPI:1124008149
Name:ETESHAM, SOHEIL (MD)
Entity Type:Individual
Prefix:MR
First Name:SOHEIL
Middle Name:
Last Name:ETESHAM
Suffix:
Gender:M
Credentials:MD
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 2287
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93303-2287
Mailing Address - Country:US
Mailing Address - Phone:661-334-1958
Mailing Address - Fax:661-324-4095
Practice Address - Street 1:420 34TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-2237
Practice Address - Country:US
Practice Address - Phone:661-327-1792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50143207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A501430Medicaid
CA00A501436Medicare PIN
CAZZZ15999ZMedicare PIN
CA00A501433Medicare PIN
CAP00427105Medicare PIN
CA00A501434Medicare PIN
CA00A501435Medicare PIN
CAZZZ21367ZMedicare PIN
CAZZZ21366ZMedicare PIN
CA00A501430Medicare PIN
CAG21141Medicare UPIN
CA00A501432Medicare PIN
CAZZZ21365ZMedicare PIN
CAZZZ34009ZMedicare PIN
CAZZZ15998ZMedicare PIN
CACD4582Medicare PIN
CA00A501431Medicare PIN