MEDICARE: PREVENTATIVE MEDICINE 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	2083A0300X	Addiction Medicine (Preventive Medicine) Physician

General Provider Information

NPI Number	:	1740806306
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREVENTATIVE MEDICINE INC

Provider Business Mailing Address
First Line	:	16400 LARK AVE STE 100
Second Line	:
City	:	LOS GATOS
State	:	CA
Zip	:	95032-2563
Country	:	US
Telephone Number	:	408-992-5141
Fax Number	:	650-999-9134

Provider Business Practice Location Address
First Line	:	16400 LARK AVE STE 100
Second Line	:
City	:	LOS GATOS
State	:	CA
Zip	:	95032-2563
Country	:	US
Telephone Number	:	408-992-5141
Fax Number	:	650-999-9134

Authorized Official
Title or Position	:	CEO, FOUNDER
Name	:	DR. SEPIDEH MOAYED
Credential	:	MD
Telephone Number	:	408-992-5141

Provider Enumeration Date	:	06/19/2020
Last Update Date	:	06/10/2025

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