Healthcare Provider Details

I. General information

NPI: 1003825175
Provider Name (Legal Business Name): MEHRNAZ JAMALI MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2006
Last Update Date: 09/01/2021
Certification Date: 09/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 PLEASANTON AVE STE 110
PLEASANTON CA
94566-7052
US

IV. Provider business mailing address

5000 PLEASANTON AVE STE 110
PLEASANTON CA
94566-7052
US

V. Phone/Fax

Practice location:
  • Phone: 925-484-4406
  • Fax: 925-484-0346
Mailing address:
  • Phone: 858-335-3310
  • Fax: 949-831-0339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA53933
License Number StateCA

VIII. Authorized Official

Name: MARJAN LOGHGMAN
Title or Position: CFO
Credential:
Phone: 858-335-3110