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Individual provider Active NPI

Mufaddal Dahodwala

  • Internal Medicine Physician
  • Valencia, CA
National Provider Identifier
1053754689
Registry record updated Oct 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A133734 Issued in CA
Practice address
25775 McBean Pkwy Ste 215
Valencia, CA 91355-3703
Phone
(661) 753-5464
Fax
(661) 753-5466
NPI assigned
Apr 13, 2013
Last updated
Oct 25, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A133734 CA Primary

Addresses

Primary practice location

25775 McBean Pkwy Ste 215
Valencia, CA 91355-3703

Mailing address

PO Box 232410
San Diego, CA 92193-2410

Other practice location 1

200 W Arbor Dr
San Diego, CA 92103-9000
Phone (800) 926-8273

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161028002166 CA Practitioner - Internal Medicine 6305124199 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Rutgers R W Johnson Medical School (Cam/New Bruns/Pisc), 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
UC San Diego Health Community GroupGroup PAC ID 3971849175, 109 clinicians

Practice addresses (Care Compare)

16950 Via Tazon
San Diego, CA 92127-1607
Phone (800) 926-8273

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.48 of 100Reported as group
Quality
92.1
Promoting interoperability
100
Improvement activities
40
Cost
69.49

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A133734CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
UC San Diego Health Community Group CurrentSince Aug 18, 2021 Accepting new patients
UCLA Medical Group Internal Medicine Past Accepting new patients
Regents of the University of California Past Accepting new patients

Locations

16950 Via Tazon
San Diego, CA 92127
Phone (858) 521-2265

200 W Arbor Dr
San Diego, CA 92103
Phone (619) 543-5754

8899 University Center Ln
San Diego, CA 92122
Phone (858) 543-7496

8899 University Center Ln
Ste 220
San Diego, CA 92122

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1365811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635120000000",
    "number": "1053754689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 232410",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921932410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25775 MCBEAN PKWY STE 215",
            "city": "VALENCIA",
            "state": "CA",
            "postal_code": "913553703",
            "telephone_number": "661-753-5464",
            "fax_number": "661-753-5466"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 W Arbor Dr",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921039000",
            "country_code": "US",
            "telephone_number": "800-926-8273",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAHODWALA",
        "first_name": "MUFADDAL",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-13",
        "last_updated": "2021-10-25",
        "certification_date": "2021-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A133734",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Valencia, CA

Sources for this page

Verify at the official NPI Registry.