Healthcare Provider Details

I. General information

NPI: 1144732397
Provider Name (Legal Business Name): ADVANCED EP DIAGNOSTICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2017
Last Update Date: 10/27/2017
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

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

V. Phone/Fax

Practice location:
  • Phone: 408-540-6861
  • Fax: 408-540-6865
Mailing address:
  • Phone: 408-540-6861
  • Fax: 408-540-6865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. EDWARD RUSTAMZADEH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 650-319-5559