Provider Demographics
NPI:1710336094
Name:POUYA AFSHAR MD INC
Entity Type:Organization
Organization Name:POUYA AFSHAR MD INC
Other - Org Name:PRESIDIUM MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:POUYA
Authorized Official - Middle Name:
Authorized Official - Last Name:AFSHAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-795-8346
Mailing Address - Street 1:8736 PRODUCTION AVE
Mailing Address - Street 2:STE B
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-2221
Mailing Address - Country:US
Mailing Address - Phone:619-795-8346
Mailing Address - Fax:
Practice Address - Street 1:3111 CAMINO DEL RIO N STE 625
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-5718
Practice Address - Country:US
Practice Address - Phone:619-738-5566
Practice Address - Fax:619-556-0202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-08
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA107069174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty