| Carlsbad Village Family Practice Medical Associates Inc | |
|
2801 Jefferson St Carlsbad CA 92008-1720 | |
| (760) 729-4952 | |
| (760) 729-2738 |
| Full Name | Carlsbad Village Family Practice Medical Associates Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 2801 Jefferson St, Carlsbad, California |
| Authorized Official Name and Position | Mahyar Ajir (PRESIDENT) |
| Authorized Official Contact | 7607294952 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Carlsbad Village Family Practice Medical Associates Inc 2801 Jefferson St Carlsbad CA 92008-1720 Ph: (760) 729-4952 | Carlsbad Village Family Practice Medical Associates Inc 2801 Jefferson St Carlsbad CA 92008-1720 Ph: (760) 729-4952 |
| NPI Number | 1972547644 |
|---|---|
| Provider Enumeration Date | 06/15/2006 |
| Last Update Date | 06/19/2014 |
| Medicare PECOS PAC ID | 4981695772 |
|---|---|
| Medicare Enrollment ID | O20040520000764 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972547644 | NPI | - | NPPES |
| GR0098810 | Medicaid | CA | |
| ZZZ09018Z | Other | BLUE CROSS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 20A6683 (California) | Secondary |
| 207Q00000X | Family Medicine | 20A6701 (California) | Primary |
| Provider Name | Mahyar Ajir |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518999218 PECOS PAC ID: 0941291736 Enrollment ID: I20040520000842 |
| Provider Name | Elaheh Etedali |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972535581 PECOS PAC ID: 8426023961 Enrollment ID: I20040830000150 |
| Provider Name | Lori K Fisher-gamez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558861740 PECOS PAC ID: 3870839905 Enrollment ID: I20190110002938 |
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