Provider Demographics
NPI:1609370360
Name:IHA GERI-PSYCH PC
Entity Type:Organization
Organization Name:IHA GERI-PSYCH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:
Authorized Official - First Name:POUYA
Authorized Official - Middle Name:
Authorized Official - Last Name:AFSHAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-738-5566
Mailing Address - Street 1:7801 MISSION CENTER CT STE 250
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1314
Mailing Address - Country:US
Mailing Address - Phone:619-738-5566
Mailing Address - Fax:
Practice Address - Street 1:7801 MISSION CENTER CT STE 250
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1314
Practice Address - Country:US
Practice Address - Phone:619-738-5566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty