Provider Demographics
NPI:1215025069
Name:BAHRAMBEYGUI, GHASSEM (MD)
Entity Type:Individual
Prefix:DR
First Name:GHASSEM
Middle Name:
Last Name:BAHRAMBEYGUI
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 1:6127 LA JOLLA BLVD
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-6727
Mailing Address - Country:US
Mailing Address - Phone:619-784-8000
Mailing Address - Fax:
Practice Address - Street 1:535 CESAR CHAVEZ BLVD
Practice Address - Street 2:
Practice Address - City:CALEXICO
Practice Address - State:CA
Practice Address - Zip Code:92231-2103
Practice Address - Country:US
Practice Address - Phone:760-357-6566
Practice Address - Fax:760-357-0849
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA23545305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA235451Medicaid
CA00A82825Medicare UPIN
CAA235451Medicaid