Healthcare Provider Details

I. General information

NPI: 1669498184
Provider Name (Legal Business Name): MARYAM JALALI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARYAM JALALI-YAZDI M.D.

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 ABBOTT ST STE 100
SALINAS CA
93901-4484
US

IV. Provider business mailing address

100 WILSON RD STE 100
MONTEREY CA
93940-7885
US

V. Phone/Fax

Practice location:
  • Phone: 831-751-7070
  • Fax:
Mailing address:
  • Phone: 831-424-7872
  • Fax: 831-424-7877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA54278
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: