Provider Demographics
NPI:1811750201
Name:SOCAL STREET MEDICINE
Entity type:Organization
Organization Name:SOCAL STREET MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHDI
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-439-9238
Mailing Address - Street 1:7245 NAVAJO RD UNIT D330
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119-1672
Mailing Address - Country:US
Mailing Address - Phone:619-439-9238
Mailing Address - Fax:
Practice Address - Street 1:7245 NAVAJO RD UNIT D330
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92119-1672
Practice Address - Country:US
Practice Address - Phone:619-439-9238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty