Provider Demographics
NPI:1891797023
Name:JAMSHIDI-NEZHAD, MOHAMMAD (DO FACS)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:
Last Name:JAMSHIDI-NEZHAD
Suffix:
Gender:M
Credentials:DO FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3998 VISTA WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4500
Mailing Address - Country:US
Mailing Address - Phone:760-724-5352
Mailing Address - Fax:760-724-5447
Practice Address - Street 1:3998 VISTA WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4500
Practice Address - Country:US
Practice Address - Phone:760-724-5352
Practice Address - Fax:760-724-5447
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A 105472086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F6090OtherMEDICARE PTAN
TX188617802Medicaid
TX8AE230OtherBLUE CROSS BLUE SHIELD
TX8AE230OtherBLUE CROSS BLUE SHIELD