Healthcare Provider Details

I. General information

NPI: 1033500145
Provider Name (Legal Business Name): PREMIER BRAIN AND SPINE INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2015
Last Update Date: 02/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 POLLARD RD BUILDING A
LOS GATOS CA
95032-1415
US

IV. Provider business mailing address

800 POLLARD RD BUILDING A
LOS GATOS CA
95032-1415
US

V. Phone/Fax

Practice location:
  • Phone: 408-540-6861
  • Fax: 408-540-6865
Mailing address:
  • Phone: 408-540-6861
  • Fax: 408-540-6865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: EDWARD RUSTAMZADEH
Title or Position: MD
Credential:
Phone: 408-540-6861