Basic Information
| Provider Information | |||||||||
| NPI: | 1427136332 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TABRIZIANI | ||||||||
| FirstName: | HOSSEIN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9610 GRANITE RIDGE DR STE B | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921232684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8588108000 | ||||||||
| FaxNumber: | 8583461024 | ||||||||
| Practice Location | |||||||||
| Address1: | 8010 FROST ST STE 510 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921234284 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8586374700 | ||||||||
| FaxNumber: | 8586374701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 04/30/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | A78291 | CA | N | Other Service Providers | Specialist | 207RN0300X | A78291 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 174400000X | MD038954 | DC | N | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 00A782910 | 05 | CA | MEDICAID | A78291 | 01 | CA | CA LICENSE | OTHER |