Individual provider Active NPI

Sanaya Hormozdyaran

  • Pediatrics Physician
  • San Diego, CA
National Provider Identifier
1750887634
Registry record updated Nov 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
A182627 Issued in CA
Practice address
2790 Truxtun Rd Ste 120a
San Diego, CA 92106-6135
Phone
(619) 222-1253
Fax
(858) 795-1195
NPI assigned
Apr 1, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 309521-01 NY
Pediatrics Physician 208000000X A182627 CA Primary

Addresses

Primary practice location

2790 Truxtun Rd Ste 120a
San Diego, CA 92106-6135

Mailing address

9850 Genesee Ave Ste 320
La Jolla, CA 92037-1208
Phone (858) 554-1212

Other practice location 1

620 E Boston Post Rd
Mamaroneck, NY 10543-3741
Phone (914) 777-5437

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221019002521 CA Practitioner - Pediatric Medicine 8729316179 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A182627CAMDPediatrics Physician
309521-01NYMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Monica Perlman MD Inc. CurrentSince Oct 12, 2022 Accepting new patients
Regents of the University of California Past Accepting new patients
UC San Diego Health - Rancho Family Medical Group Past Accepting new patients
Rady Children's Hospital San Diego Past Accepting new patients

Locations

9850 Genesee Ave
Ste 320
La Jolla, CA 92037
Phone (858) 864-9800

2790 Truxtun Rd
Ste 120A
San Diego, CA 92106
Phone (619) 222-1253

3737 Moraga Ave
Ste B103
San Diego, CA 92117
Phone (858) 799-0855

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1522540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667779200000",
    "number": "1750887634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9850 GENESEE AVE STE 320",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920371208",
            "telephone_number": "858-554-1212",
            "fax_number": "858-795-1195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2790 TRUXTUN RD STE 120A",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921066135",
            "telephone_number": "619-222-1253",
            "fax_number": "858-795-1195"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "620 E Boston Post Rd",
            "address_purpose": "LOCATION",
            "city": "Mamaroneck",
            "state": "NY",
            "postal_code": "105433741",
            "country_code": "US",
            "telephone_number": "914-777-5437",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HORMOZDYARAN",
        "first_name": "SANAYA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-01",
        "last_updated": "2022-11-07",
        "certification_date": "2022-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "309521-01",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A182627",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.