Healthcare Provider Details

I. General information

NPI: 1093144008
Provider Name (Legal Business Name): ISMAH JAWED MSPAS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ISMAH JAWED JAYOUSI

II. Dates (important events)

Enumeration Date: 11/11/2013
Last Update Date: 02/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1999 MOWRY AVE SUITE F
FREMONT CA
94538-1738
US

IV. Provider business mailing address

1999 MOWRY AVE SUITE F
FREMONT CA
94538-1738
US

V. Phone/Fax

Practice location:
  • Phone: 510-770-8040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA51255
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: