Healthcare Provider Details

I. General information

NPI: 1770014367
Provider Name (Legal Business Name): AMBREEN ZAMAN P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMBREEN QURESHI P.A.

II. Dates (important events)

Enumeration Date: 03/24/2017
Last Update Date: 05/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3315 BROADWAY STREET LEVEL
OAKLAND CA
94611-5717
US

IV. Provider business mailing address

200 PORTER DR SUITE 215
SAN RAMON CA
94583-1587
US

V. Phone/Fax

Practice location:
  • Phone: 510-486-2300
  • Fax: 510-486-2333
Mailing address:
  • Phone: 925-362-2166
  • Fax: 855-574-3055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA54286
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: