Provider Demographics
NPI:1306197447
Name:PAYAM MEHRANPOUR, INC.
Entity Type:Organization
Organization Name:PAYAM MEHRANPOUR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHRANPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-377-6262
Mailing Address - Street 1:8851 CENTER DR STE 405
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3198
Mailing Address - Country:US
Mailing Address - Phone:619-377-6262
Mailing Address - Fax:888-533-3130
Practice Address - Street 1:8851 CENTER DR STE 405
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3198
Practice Address - Country:US
Practice Address - Phone:619-377-6262
Practice Address - Fax:888-533-3130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA112670207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty