Provider Demographics
NPI:1801049317
Name:ENAYATI, MEHR (BA)
Entity type:Individual
Prefix:
First Name:MEHR
Middle Name:
Last Name:ENAYATI
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:MEHR
Other - Middle Name:
Other - Last Name:ENAYATI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BA
Mailing Address - Street 1:8755 AERO DR
Mailing Address - Street 2:#100
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1776
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7798 STARLING DR
Practice Address - Street 2:#314
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2742
Practice Address - Country:US
Practice Address - Phone:858-492-2350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator