Basic Information
Provider Information
NPI: 1245459973
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NEYAZ
FirstName: MOHAMMED
MiddleName: DANISH
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4225 EXECUTIVE SQ STE 450
Address2:  
City: LA JOLLA
State: CA
PostalCode: 920378411
CountryCode: US
TelephoneNumber: 8588100000
FaxNumber: 8582681911
Practice Location
Address1: 631 E GRAND AVE
Address2:  
City: ESCONDIDO
State: CA
PostalCode: 920254402
CountryCode: US
TelephoneNumber: 7602941660
FaxNumber: 7607455016
Other Information
ProviderEnumerationDate: 04/24/2007
LastUpdateDate: 02/02/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/02/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RN0300XA13534CAY Allopathic & Osteopathic PhysiciansInternal MedicineNephrology

No ID Information.


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