MEDICARE: ALEX A MIRABADI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QG0300X	Geriatric Medicine (Family Medicine) Physician	A130405	CA

General Provider Information

NPI Number	:	1396037545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEX A MIRABADI M.D.

Provider Business Mailing Address
First Line	:	4261 DELACROIX CT
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95135-1722
Country	:	US
Telephone Number	:	302-668-9445
Fax Number	:

Provider Business Practice Location Address
First Line	:	299 STOCKTON AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95126-2763
Country	:	US
Telephone Number	:	408-535-4600
Fax Number	:	408-291-5952

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2011
Last Update Date	:	12/20/2018

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