Provider Demographics
NPI:1679750574
Name:BANDARI, ARMIN J (MD, FACC)
Entity Type:Individual
Prefix:
First Name:ARMIN
Middle Name:J
Last Name:BANDARI
Suffix:
Gender:M
Credentials:MD, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 JOHNSON AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-4154
Mailing Address - Country:US
Mailing Address - Phone:805-782-8844
Mailing Address - Fax:833-613-2634
Practice Address - Street 1:1941 JOHNSON AVE
Practice Address - Street 2:STE 101
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4154
Practice Address - Country:US
Practice Address - Phone:805-782-8844
Practice Address - Fax:833-613-2634
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA105051207UN0901X, 207RC0000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0068680Medicaid
CAP00738462OtherRR MEDICARE
CAZZZ40450ZOtherBLUE SHIELD
CAAM401WMedicare PIN
CAAM401YMedicare PIN
CAZZZ40450ZOtherBLUE SHIELD
CAGR0068680Medicaid
CAAM401YMedicare PIN
CAAM401ZMedicare PIN
CAP00738462OtherRR MEDICARE