Provider Demographics
NPI:1538116702
Name:SAMETI, MAHNAZ (MD)
Entity Type:Individual
Prefix:
First Name:MAHNAZ
Middle Name:
Last Name:SAMETI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:FATEMEH
Other - Middle Name:M
Other - Last Name:SAMETI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 969096
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92196-9096
Mailing Address - Country:US
Mailing Address - Phone:858-495-0971
Mailing Address - Fax:858-495-0991
Practice Address - Street 1:6719 ALVARADO RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-5270
Practice Address - Country:US
Practice Address - Phone:858-495-0971
Practice Address - Fax:858-495-0991
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34154207L00000X
CAC54511207LA0401X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ67863Medicare PIN
AZI39294Medicare UPIN
AZZ116878Medicare PIN