Individual
TINA NIKOOMANESH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
4077 FIFTH AVE # MER35, SAN DIEGO, CA 92103-2105
(619) 294-8111
Mailing address
4077 FIFTH AVE # MER35, SAN DIEGO, CA 92103-2105
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
20A17855
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/21/2018
Last updated
07/13/2023
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