Healthcare Provider Details

I. General information

NPI: 1225669674
Provider Name (Legal Business Name): MITERA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2020
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1049 EL MONTE AVE STE C #633
MOUNTAIN VIEW CA
94040
US

IV. Provider business mailing address

1049 EL MONTE AVE STE C #633
MOUNTAIN VIEW CA
94040
US

V. Phone/Fax

Practice location:
  • Phone: 650-646-7575
  • Fax:
Mailing address:
  • Phone: 650-646-7575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: SAMAN ASKARI
Title or Position: COO
Credential:
Phone: 650-646-7575