Healthcare Provider Details

I. General information

NPI: 1619375615
Provider Name (Legal Business Name): DANA ELIZABETH MIRZA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2014
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 EMBARCADERO CTR STE 1900
SAN FRANCISCO CA
94111-3723
US

IV. Provider business mailing address

1 EMBARCADERO CTR STE 1900
SAN FRANCISCO CA
94111-3723
US

V. Phone/Fax

Practice location:
  • Phone: 415-658-6791
  • Fax: 415-520-0904
Mailing address:
  • Phone: 415-658-6791
  • Fax: 415-520-0904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA159949
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: