Provider Demographics
NPI:1154323996
Name:SHEREV, DIMITRI ATANASOV (MD)
Entity Type:Individual
Prefix:
First Name:DIMITRI
Middle Name:ATANASOV
Last Name:SHEREV
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 1:1380 EL CAJON BLVD STE 212
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-5760
Mailing Address - Country:US
Mailing Address - Phone:619-867-0557
Mailing Address - Fax:619-867-0558
Practice Address - Street 1:1380 EL CAJON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-5760
Practice Address - Country:US
Practice Address - Phone:619-867-0557
Practice Address - Fax:619-867-0558
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70917207RC0000X, 207UN0901X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A709170Medicaid
CAWA70917AMedicare PIN
CAH59470Medicare UPIN