Provider Demographics
NPI:1992063036
Name:AFSHAR, MARYAM (MD)
Entity type:Individual
Prefix:DR
First Name:MARYAM
Middle Name:
Last Name:AFSHAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARYAM
Other - Middle Name:
Other - Last Name:IZADPANAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 504048
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92150-4048
Mailing Address - Country:US
Mailing Address - Phone:760-758-5340
Mailing Address - Fax:760-758-5502
Practice Address - Street 1:8899 UNIVERSITY CENTER LN STE 350
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-1010
Practice Address - Country:US
Practice Address - Phone:858-657-8322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-26
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA132453207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program