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General NPI Number Information
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NPI Number | 1891150397
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Entity Type | Individual
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Provider Name | MAHKAM TAVALLAEE M.D., M.P.H.
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Gender | Female
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Dates
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Enumeration Date | 12/28/2015
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 2450 ASHBY AVE
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City | BERKELEY
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State | CA
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Zip | 94705-2067
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Country | US
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Telephone | 510-204-4444
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Fax |
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Provider Business Mailing Address
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Address Line | 300 PASTEUR DR RM L235
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City | STANFORD
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State | CA
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Zip | 94305-2200
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Country | US
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Telephone | 650-723-5252
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | A154555
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 154555
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License Number State | CA
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