Healthcare Provider Details

I. General information

NPI: 1073141099
Provider Name (Legal Business Name): OMEED ATEFI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 CAMINO ENCINAS
ORINDA CA
94563-3304
US

IV. Provider business mailing address

3569 ROUND BARN CIR STE 200
SANTA ROSA CA
95403-5784
US

V. Phone/Fax

Practice location:
  • Phone: 510-204-8189
  • Fax: 510-506-7724
Mailing address:
  • Phone: 707-583-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number20A20566
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A20566
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: