MEDICARE: MISSION PEAK ORTHOPAEDIC MEDICAL GROUP, INC

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	207X00000X	Orthopaedic Surgery Physician	A657720	CA
2	208100000X	Physical Medicine & Rehabilitation Physician	A81391	CA
3	208100000X	Physical Medicine & Rehabilitation Physician	A95318	CA
4	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	A81391	CA
5	213ES0103X	Foot & Ankle Surgery Podiatrist	E4711	CA
6	363A00000X	Physician Assistant	PA17256	CA
7	363AS0400X	Surgical Physician Assistant	PA17256	CA
8	207X00000X	Orthopaedic Surgery Physician	A698780	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ5427Z	OTHER	CA	BLUE SHIELD

General Provider Information

NPI Number	:	1639282551
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSION PEAK ORTHOPAEDIC MEDICAL GROUP, INC

Provider Business Mailing Address
First Line	:	686 MOWRY AVE
Second Line	:
City	:	FREMONT
State	:	CA
Zip	:	94536-4113
Country	:	US
Telephone Number	:	510-797-3933
Fax Number	:	510-797-5184

Provider Business Practice Location Address
First Line	:	5924 STONERIDGE DRIVE
Second Line	:	SUITE 110
City	:	PLEASANTON
State	:	CA
Zip	:	94588-5400
Country	:	US
Telephone Number	:	925-846-6200
Fax Number	:	510-797-5184

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	LINGAGOUD MEMULA
Credential	:
Telephone Number	:	510-818-2011

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	10/18/2012

Similar Medicare Providers

1538023510 — ONESTOP MEDICAL CENTER
Practice Location Address:

5924 STONERIDGE DR STE 110
PLEASANTON, CA
94588-5400

Practice Phone: 925-263-9547
Practice Fax: 800-507-0849

1669401147 — JOAN HART N.P.
Practice Location Address:

5924 STONERIDGE DR STE 202
PLEASANTON, CA
94588-5400

Practice Phone: 925-287-1256
Practice Fax: 925-287-0913

1588758148 — DR. IQBAL INAYAT OMARALI M.D.
Practice Location Address:

5924 STONERIDGE DR STE 103
PLEASANTON, CA
94588-5400

Practice Phone: 925-918-2415
Practice Fax: 925-420-7342

1174618219 — PLEASANTON MEDICAL GROUP
Practice Location Address:

5924 STONERIDGE DR STE 103
PLEASANTON, CA
94588-5400

Practice Phone: 925-417-7505
Practice Fax:

1578658795 — DR. TASNEEM BADER-OMARALI M.D.
Practice Location Address:

5924 STONERIDGE DR STE 103
PLEASANTON, CA
94588-5400

Practice Phone: 925-417-7505
Practice Fax:

1841466471 — ANUJA GARG MD
Practice Location Address:

5924 STONERIDGE DR STE 110
PLEASANTON, CA
94588-5400

Practice Phone: 925-263-9547
Practice Fax: 925-247-1576

Directions to “MISSION PEAK ORTHOPAEDIC MEDICAL GROUP, INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.