Provider Demographics
NPI:1962521419
Name:FIROOZNIA, NILOFAR (MD)
Entity type:Individual
Prefix:
First Name:NILOFAR
Middle Name:
Last Name:FIROOZNIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2005
Mailing Address - Country:US
Mailing Address - Phone:858-658-6501
Mailing Address - Fax:
Practice Address - Street 1:150 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2005
Practice Address - Country:US
Practice Address - Phone:619-295-9729
Practice Address - Fax:619-295-2549
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2290372085R0202X
CAA1098062085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02889045Medicaid
CA1962521419Medicaid
CA1962521419Medicaid
CACB251866Medicare PIN