Healthcare Provider Details

I. General information

NPI: 1487516886
Provider Name (Legal Business Name): MAHSHID AMINI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2025
Last Update Date: 11/25/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4377 TERRABELLA WAY
OAKLAND CA
94619-3163
US

IV. Provider business mailing address

4377 TERRABELLA WAY
OAKLAND CA
94619-3163
US

V. Phone/Fax

Practice location:
  • Phone: 510-850-7648
  • Fax:
Mailing address:
  • Phone: 510-850-7648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC42819
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: