Healthcare Provider Details

I. General information

NPI: 1386117794
Provider Name (Legal Business Name): MSALAM M SARA MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2019
Last Update Date: 03/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 SAMARITAN DR STE D
SAN JOSE CA
95124-4104
US

IV. Provider business mailing address

PO BOX 33142
LOS GATOS CA
95031-3142
US

V. Phone/Fax

Practice location:
  • Phone: 408-298-0433
  • Fax: 408-295-8818
Mailing address:
  • Phone: 408-610-2001
  • Fax: 408-610-3880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MSALAM MTANOUS SARA
Title or Position: OWNER
Credential: MD
Phone: 408-610-2001