Provider Demographics
NPI:1922494681
Name:THE DOCTORS OFFICE & WALK-IN CLINIC CA INC.
Entity Type:Organization
Organization Name:THE DOCTORS OFFICE & WALK-IN CLINIC CA INC.
Other - Org Name:MORTEZA MIRKARIMI M.D., INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHAJAN
Authorized Official - Suffix:
Authorized Official - Credentials:NMD
Authorized Official - Phone:646-652-1791
Mailing Address - Street 1:3863 CLAIREMONT DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-5831
Mailing Address - Country:US
Mailing Address - Phone:858-483-5570
Mailing Address - Fax:858-483-5572
Practice Address - Street 1:3863 CLAIREMONT DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-5831
Practice Address - Country:US
Practice Address - Phone:858-483-5570
Practice Address - Fax:858-483-5572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-09
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39662208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty