Provider Demographics
NPI:1508904657
Name:GHAHREMANI, SIMIN M (MD)
Entity Type:Individual
Prefix:
First Name:SIMIN
Middle Name:M
Last Name:GHAHREMANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 3RD AVE STE 2200
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-1353
Mailing Address - Country:US
Mailing Address - Phone:619-426-0100
Mailing Address - Fax:619-426-2170
Practice Address - Street 1:855 3RD AVE STE 2200
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-1353
Practice Address - Country:US
Practice Address - Phone:619-426-0100
Practice Address - Fax:619-426-2170
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC511102080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC51110OtherLICENSE