Provider Demographics
NPI:1588924849
Name:MOZAYAN-ISFAHANI, EHSAN (MD)
Entity type:Individual
Prefix:
First Name:EHSAN
Middle Name:
Last Name:MOZAYAN-ISFAHANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:477 N EL CAMINO REAL
Mailing Address - Street 2:STE C302
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1354
Mailing Address - Country:US
Mailing Address - Phone:760-300-3270
Mailing Address - Fax:760-300-3270
Practice Address - Street 1:477 N EL CAMINO REAL
Practice Address - Street 2:STE C302
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-1354
Practice Address - Country:US
Practice Address - Phone:760-300-3270
Practice Address - Fax:760-300-3270
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR72481208600000X
CAA137252207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No208600000XAllopathic & Osteopathic PhysiciansSurgery