MEDICARE: DR. MICHAEL M JADALI D.O. , RPH

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	208100000X	Physical Medicine & Rehabilitation Physician	20A9504	CA
2	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	20A9504	CA
3	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician	20A9504	CA
4	204C00000X	Sports Medicine (Neuromusculoskeletal Medicine) Physician	20A9504	CA
5	204D00000X	Neuromusculoskeletal Medicine & OMM Physician	20A9504	CA

General Provider Information

NPI Number	:	1891723375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL M JADALI D.O. , RPH

Provider Business Mailing Address
First Line	:	3097 MOORPARK AVE STE 200
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95128-2543
Country	:	US
Telephone Number	:	408-244-7246
Fax Number	:	408-244-7248

Provider Business Practice Location Address
First Line	:	3097 MOORPARK AVE STE 200
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95128-2543
Country	:	US
Telephone Number	:	408-244-7246
Fax Number	:	408-244-7248

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

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	01/15/2025

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