Healthcare Provider Details

I. General information

NPI: 1952482366
Provider Name (Legal Business Name): AAFTAB MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 03/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15921 E 14TH ST
SAN LEANDRO CA
94578-3005
US

IV. Provider business mailing address

15921 E 14TH ST
SAN LEANDRO CA
94578-3005
US

V. Phone/Fax

Practice location:
  • Phone: 510-278-1123
  • Fax: 510-278-1267
Mailing address:
  • Phone: 510-278-1123
  • Fax: 510-278-1267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberA508260
License Number StateCA

VIII. Authorized Official

Name: DR. NAIM SAFIULLAH KATIBY
Title or Position: PRESIDENT AND DIRECTOR
Credential: MD
Phone: 510-278-1123