Healthcare Provider Details

I. General information

NPI: 1477573285
Provider Name (Legal Business Name): CENTER FOR PAIN & REHABILITATION MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3097 MOORPARK AVE STE 200
SAN JOSE CA
95128-2543
US

IV. Provider business mailing address

3097 MOORPARK AVE STE 200
SAN JOSE CA
95128-2543
US

V. Phone/Fax

Practice location:
  • Phone: 408-244-7246
  • Fax: 408-244-7248
Mailing address:
  • Phone: 408-244-7246
  • Fax: 408-244-7248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081P0301X
TaxonomyBrain Injury Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL M JADALI
Title or Position: MEDICAL DIRECTOR
Credential: DO
Phone: 408-244-7246