Provider Demographics
NPI:1437174349
Name:BEHZAD BANIADAM MD APC
Entity Type:Organization
Organization Name:BEHZAD BANIADAM MD APC
Other - Org Name:MISSION URGENT CARE, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:BEHZAD
Authorized Official - Middle Name:
Authorized Official - Last Name:BANIADAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-630-6300
Mailing Address - Street 1:1618 BURGUNDY RD
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1207
Mailing Address - Country:US
Mailing Address - Phone:760-630-6300
Mailing Address - Fax:760-630-1100
Practice Address - Street 1:3231 WARING CT STE L
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4510
Practice Address - Country:US
Practice Address - Phone:760-630-6300
Practice Address - Fax:760-630-1100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP31640261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D1022589OtherCLIA
CA05D1022589OtherCLIA