Provider Demographics
NPI:1972547644
Name:CARLSBAD VILLAGE FAMILY PRACTICE MEDICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:CARLSBAD VILLAGE FAMILY PRACTICE MEDICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAHYAR
Authorized Official - Middle Name:
Authorized Official - Last Name:AJIR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:760-729-4952
Mailing Address - Street 1:2801 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1720
Mailing Address - Country:US
Mailing Address - Phone:760-729-4952
Mailing Address - Fax:760-729-2738
Practice Address - Street 1:2801 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1720
Practice Address - Country:US
Practice Address - Phone:760-729-4952
Practice Address - Fax:760-729-2738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6683207Q00000X
CA20A6701207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0098810Medicaid
ZZZ09018ZOtherBLUE CROSS
ZZZ09018ZOtherBLUE CROSS
Y07685Medicare UPIN