Healthcare Provider Details

I. General information

NPI: 1457538449
Provider Name (Legal Business Name): ROOZBEH MOHAJER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MOHAJER MEDICAL CORPORATION MD

II. Dates (important events)

Enumeration Date: 01/22/2008
Last Update Date: 06/03/2020
Certification Date: 06/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 EL CAMINO REAL FL 2
PALO ALTO CA
94301
US

IV. Provider business mailing address

325 DISTEL CIR
LOS ALTOS CA
94022-1408
US

V. Phone/Fax

Practice location:
  • Phone: 650-853-2905
  • Fax: 650-853-2966
Mailing address:
  • Phone: 650-853-2905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA110400
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberA110400
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA110400
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: