Provider Demographics
NPI:1265458087
Name:NAIMARK, DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:NAIMARK
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 1:220 W BROADWAY
Mailing Address - Street 2:#1003
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-3886
Mailing Address - Country:US
Mailing Address - Phone:619-531-3257
Mailing Address - Fax:619-531-3668
Practice Address - Street 1:220 W BROADWAY
Practice Address - Street 2:#1003
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-3886
Practice Address - Country:US
Practice Address - Phone:619-531-3257
Practice Address - Fax:619-531-3668
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG754882084F0202X, 2084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G754880Medicaid
CAWG75488KMedicare ID - Type Unspecified
CA00G754880Medicaid