Provider Demographics
NPI:1134616766
Name:ALLAHDADI, BASHIR (MD)
Entity type:Individual
Prefix:MR
First Name:BASHIR
Middle Name:
Last Name:ALLAHDADI
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 1:836 ANACAPA ST P.O. BOX 22336
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93121
Mailing Address - Country:US
Mailing Address - Phone:916-547-9410
Mailing Address - Fax:805-569-8358
Practice Address - Street 1:400 W PUEBLO STREET
Practice Address - Street 2:SBCH, MEDICAL EDUCATION OFFICE
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105
Practice Address - Country:US
Practice Address - Phone:916-547-9410
Practice Address - Fax:805-569-8358
Is Sole Proprietor?:No
Enumeration Date:2018-04-19
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA173353207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program