Individual provider Active NPI

Bahareh Tahriri

  • Physician Assistant
  • San Marcos, CA
National Provider Identifier
1295147387
Registry record updated Jun 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
51867 Issued in CA
Practice address
150 Valpreda Rd
San Marcos, CA 92069-2973
Phone
(760) 736-6780
NPI assigned
May 23, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 51867 CA Primary

Addresses

Primary practice location

150 Valpreda Rd
San Marcos, CA 92069-2973

Mailing address

150 Valpreda Rd
San Marcos, CA 92069-2973
Phone (760) 736-6780

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160830002956 CA Practitioner - Physician Assistant 7810117389 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
North County Health Project Inc CurrentSince Jul 12, 2021 Accepting new patients
Family Health Centers of San Diego, Inc. CurrentSince Jun 20, 2016 Accepting new patients
Family Health Centers of San Diego, Inc CurrentSince Jun 20, 2016 Accepting new patients
North County Health Project Inc CurrentSince Jul 12, 2021 Accepting new patients
Winnebago Indian Health Service Past Accepting new patients

Locations

4874 Polk Ave
San Diego, CA 92105
Phone (619) 515-2426

823 Gateway Center Way
San Diego, CA 92102
Phone (619) 515-2323

150 Valpreda Rd
San Marcos, CA 92069
Phone (619) 736-6700

Interoperability endpoints

  • Direct secure messaging: btahriri349054@direct.ochin.org

Organizations & group practices 7

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

NPI Registry JSON

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

{
    "created_epoch": "1400803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624406400000",
    "number": "1295147387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 VALPREDA RD",
            "city": "SAN MARCOS",
            "state": "CA",
            "postal_code": "920692973",
            "telephone_number": "760-736-6780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 VALPREDA RD",
            "city": "SAN MARCOS",
            "state": "CA",
            "postal_code": "920692973",
            "telephone_number": "760-736-6780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAHRIRI",
        "first_name": "BAHAREH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-05-23",
        "last_updated": "2021-06-23",
        "certification_date": "2021-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "51867",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Marcos, CA

Sources for this page

Verify at the official NPI Registry.