Organization
BTLA VI
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BEHZAD TAGHIZADEH M.D. (MANAGER)
(336) 414-6079
Entity
Organization
Contact information
Practice address
5555 RESERVOIR DR, SUITE #209, SAN DIEGO, CA 92120-5134
(336) 414-6079
Mailing address
5555 RESERVOIR DR, SUITE #209, SAN DIEGO, CA 92120-5134
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
C58208
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1275514986
—
CA
Enumeration date
01/05/2015
Last updated
01/05/2015
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