Provider Demographics
NPI:1790897387
Name:MEHRANPOUR, PAYAM (MD)
Entity Type:Individual
Prefix:DR
First Name:PAYAM
Middle Name:
Last Name:MEHRANPOUR
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 1:8851 CENTER DR
Mailing Address - Street 2:SUITE 405
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3017
Mailing Address - Country:US
Mailing Address - Phone:619-377-6262
Mailing Address - Fax:888-533-3130
Practice Address - Street 1:8851 CENTER DR
Practice Address - Street 2:SUITE 405
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3017
Practice Address - Country:US
Practice Address - Phone:619-377-6262
Practice Address - Fax:888-533-3130
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA112670207RC0000X, 207RI0011X
GA056589207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI51311Medicare UPIN
GA11SCGBWMedicare ID - Type Unspecified
GAI51311Medicare UPIN