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General NPI Number Information
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NPI Number | 1871789446
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Entity Type | Organization
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Legal Business Name | MITRA EMAMI INC
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Dates
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Enumeration Date | 09/18/2007
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Last Update Date | 10/11/2007
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Provider Practice Location Address
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Address Line | 2516 SAMARITAN DR STE K
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City | SAN JOSE
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State | CA
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Zip | 95124-4108
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Country | US
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Telephone | 408-358-6525
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Fax |
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Provider Business Mailing Address
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Address Line | 2516 SAMARITAN DR
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City | SAN JOSE
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State | CA
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Zip | 95124-4108
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Country | US
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Telephone | 408-358-6525
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN / OWNER
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Name | MITRA EMAMI
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Credential | MD
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Telephone | 408-358-6525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | A66854
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License Number State | CA
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