Healthcare Provider Details

I. General information

NPI: 1225198351
Provider Name (Legal Business Name): MUNEEZA MIRZA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 06/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 FOREST AVE., SUITE #110 PEDIATRIC CENTER FOR LIFE
SAN JOSE CA
95128
US

IV. Provider business mailing address

2030 FOREST AVE., SUITE 110 PEDIATRIC CENTER FOR LIFE
SAN JOSE CA
95128
US

V. Phone/Fax

Practice location:
  • Phone: 408-947-2929
  • Fax: 408-947-2926
Mailing address:
  • Phone: 408-947-2929
  • Fax: 408-947-2926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301072758
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC53344
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: