Provider Demographics
NPI:1841362241
Name:ISLAMI MANUCHEHRY, MOHAMMAD HOSEIN (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:HOSEIN
Last Name:ISLAMI MANUCHEHRY
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 1:9425 QUAIL CANYON ROAD
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021
Mailing Address - Country:US
Mailing Address - Phone:619-938-1841
Mailing Address - Fax:619-390-5237
Practice Address - Street 1:9425 QUAIL CANYON ROAD
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021
Practice Address - Country:US
Practice Address - Phone:619-938-1841
Practice Address - Fax:619-390-5237
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50491208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C504910Medicaid
CA00C504910Medicaid