Provider Demographics
NPI:1659366292
Name:AMANI, RAMIN (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMIN
Middle Name:
Last Name:AMANI
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 1:18766 ACEITURO ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-1301
Mailing Address - Country:US
Mailing Address - Phone:858-761-2802
Mailing Address - Fax:760-439-4841
Practice Address - Street 1:950 CIVIC CENTER DR # A
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-5208
Practice Address - Country:US
Practice Address - Phone:760-439-4839
Practice Address - Fax:760-439-4841
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA539842080A0000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A539840Medicaid