Healthcare Provider Details

I. General information

NPI: 1871789446
Provider Name (Legal Business Name): MITRA EMAMI INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2516 SAMARITAN DR STE K
SAN JOSE CA
95124-4108
US

IV. Provider business mailing address

2516 SAMARITAN DR
SAN JOSE CA
95124-4108
US

V. Phone/Fax

Practice location:
  • Phone: 408-358-6525
  • Fax:
Mailing address:
  • Phone: 408-358-6525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberA66854
License Number StateCA

VIII. Authorized Official

Name: MITRA EMAMI
Title or Position: PHYSICIAN / OWNER
Credential: MD
Phone: 408-358-6525