Healthcare Provider Details

I. General information

NPI: 1134652282
Provider Name (Legal Business Name): FIRAS AJAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2017
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 NIELSON ST STE 135
WATSONVILLE CA
95076-2491
US

IV. Provider business mailing address

1850 EL CAMINO REAL STE 200
BURLINGAME CA
94010-3102
US

V. Phone/Fax

Practice location:
  • Phone: 831-717-4687
  • Fax: 831-901-3160
Mailing address:
  • Phone: 650-697-2431
  • Fax: 650-697-3659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberC201604
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberC201604
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberC201604
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: