1962072819 NPI number — TELE-RHEUMATOLOGY MEDICAL ASSOCIATES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962072819 NPI number — TELE-RHEUMATOLOGY MEDICAL ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TELE-RHEUMATOLOGY MEDICAL ASSOCIATES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962072819
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3790 EL CAMINO REAL
Provider Second Line Business Mailing Address:
# 564
Provider Business Mailing Address City Name:
PALO ALTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-215-4040
Provider Business Mailing Address Fax Number:
831-480-1328

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
268 GREEN VALLEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREEDOM
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95019-3139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-204-7787
Provider Business Practice Location Address Fax Number:
831-480-1328
Provider Enumeration Date:
07/01/2021

Additional Information

Authorized Official

Authorized Official Last Name:
SALAHUDDIN
Authorized Official First Name:
FARAH
Authorized Official Middle Name:
F
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
831-215-4040

Provider Taxonomy Codes

  • Taxonomy code: 207RR0500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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