Provider Demographics
NPI:1164426953
Name:BAHREMAN, AMIRHASSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:AMIRHASSAN
Middle Name:
Last Name:BAHREMAN
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 1:8851 CENTER DR
Mailing Address - Street 2:SUITE 608
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3017
Mailing Address - Country:US
Mailing Address - Phone:619-460-5850
Mailing Address - Fax:619-460-5849
Practice Address - Street 1:8851 CENTER DR
Practice Address - Street 2:SUITE 608
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3017
Practice Address - Country:US
Practice Address - Phone:619-460-5850
Practice Address - Fax:619-460-5849
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059340A2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200498540Medicaid
IN200498540Medicaid
IN498700IMedicare ID - Type Unspecified