Provider Demographics
NPI:1518021369
Name:RAISZADEH, RAMIN (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMIN
Middle Name:
Last Name:RAISZADEH
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 1:6719 ALVARADO ROAD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120
Mailing Address - Country:US
Mailing Address - Phone:619-265-7912
Mailing Address - Fax:619-265-7922
Practice Address - Street 1:6719 ALVARADO ROAD
Practice Address - Street 2:SUITE 308
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120
Practice Address - Country:US
Practice Address - Phone:619-265-7912
Practice Address - Fax:619-265-7922
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88341207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA88341OtherSTATE LICENSE
CAA88341OtherSTATE LICENSE
CAWA88341AMedicare UPIN