PAUL CYRUS KASRAZADEH
NPI 1124777024
Student in an Organized Health Care Education/Training Program in San Diego, CA

Q: What is Paul Kasrazadeh's NPI number?

The NPI number for Paul Kasrazadeh is 1124777024. It was assigned to this individual provider in the NPPES registry on March 20, 2022.

Q: What is Paul Kasrazadeh's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Paul Kasrazadeh was last updated on July 25, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since March 20, 2022PECOS Enrolled

6911 CONVOY CT FL 2, SAN DIEGO, CA 92111(858) 573-6409 Get Directions Write a Review

NPPES record last updated: July 25, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Paul Cyrus Kasrazadeh NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PAUL CYRUS KASRAZADEH (NPI 1124777024) is an individual student in an organized health care education/training program in San Diego, California and active in the NPI registry since March 2022. He is enrolled in Medicare PECOS and is a graduate of Other (2022).

NPPES Registry Identity

NPI1124777024

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NamePAUL CYRUS KASRAZADEH

Location Address6911 CONVOY CT FL 2San Diego, CA 92111-1014

Mailing Address6911 Convoy Ct Fl 2San Diego, CA 92111-1014

Phone(858) 573-6409

Sole ProprietorNo

Medical School CMSOtherGraduated 2022

Enumeration DateMarch 20, 2022

Last NPPES UpdateJuly 25, 2022

NPPES CertifiedMarch 20, 2022

✔ NPI 1124777024 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

6911 CONVOY CT FL 2, San Diego, CA 92111

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Paul Cyrus Kasrazadeh is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID3971950338

PECOS Enrollment IDI20251031000070

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

RAVEN BENNETT MD

Student in an Organized Health Care Education/Training Program