Healthcare Provider Details

I. General information

NPI: 1386707651
Provider Name (Legal Business Name): OMEED AZIZIRAD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 08/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 MOWRY AVE
FREMONT CA
94538-1716
US

IV. Provider business mailing address

2000 MOWRY AVE
FREMONT CA
94538-1716
US

V. Phone/Fax

Practice location:
  • Phone: 510-797-1111
  • Fax:
Mailing address:
  • Phone: 510-797-1111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2006002051
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA99519
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: