Healthcare Provider Details

I. General information

NPI: 1598977522
Provider Name (Legal Business Name): PARMIS YEGANEH RAD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1466 LINCOLN AVE
SAN RAFAEL CA
94901-2021
US

IV. Provider business mailing address

113 E EL CAMINITO DR
PHOENIX AZ
85020-3503
US

V. Phone/Fax

Practice location:
  • Phone: 415-457-3755
  • Fax: 415-457-0849
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number77395
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberC168795
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: