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General NPI Number Information
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NPI Number | 1518217769
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Entity Type | Organization
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Legal Business Name | PARVEZ FATTEH, MD A MEDICAL CORPORATION
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Dates
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Enumeration Date | 09/14/2012
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Last Update Date | 09/14/2012
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Provider Practice Location Address
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Address Line | 2287 MOWRY AVE STE. H
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City | FREMONT
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State | CA
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Zip | 94538-1622
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Country | US
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Telephone | 510-742-5795
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Fax | 510-742-5799
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Provider Business Mailing Address
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Address Line | 5820 STONERIDGE MALL RD #203
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City | PLEASANTON
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State | CA
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Zip | 94588-3274
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Country | US
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Telephone | 510-742-5795
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Fax | 510-742-5799
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PARVEZ MEHBOOB FATTEH
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Credential | M.D.
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Telephone | 510-742-5795
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | A66560
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License Number State | CA
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