Basic Information
| Provider Information | |||||||||
| NPI: | 1962521419 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FIROOZNIA | ||||||||
| FirstName: | NILOFAR | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 150 W WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921032005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8586586501 | ||||||||
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| Practice Location | |||||||||
| Address1: | 150 W WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921032005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192959729 | ||||||||
| FaxNumber: | 6192952549 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2007 | ||||||||
| LastUpdateDate: | 02/09/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | A109806 | CA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 1962521419 | 05 | CA | MEDICAID |