Healthcare Provider Details

I. General information

NPI: 1164752242
Provider Name (Legal Business Name): TABATABAI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2010
Last Update Date: 01/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2255 CONTRA COSTA BLVD STE 305
PLEASANT HILL CA
94523-3784
US

IV. Provider business mailing address

2255 CONTRA COSTA BLVD STE 305
PLEASANT HILL CA
94523-3784
US

V. Phone/Fax

Practice location:
  • Phone: 925-405-9626
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberA38282
License Number StateCA

VIII. Authorized Official

Name: MEHER F TABATABAI
Title or Position: OWNER
Credential: MD
Phone: 925-405-9626