1518217769 NPI number — PARVEZ FATTEH, MD A MEDICAL CORPORATION

Table of content: (NPI 1518217769)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518217769 NPI number — PARVEZ FATTEH, MD A MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARVEZ FATTEH, MD A MEDICAL CORPORATION
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:
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:
1518217769
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5820 STONERIDGE MALL RD
Provider Second Line Business Mailing Address:
#203
Provider Business Mailing Address City Name:
PLEASANTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94588-3274
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-742-5795
Provider Business Mailing Address Fax Number:
510-742-5799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2287 MOWRY AVE
Provider Second Line Business Practice Location Address:
STE. H
Provider Business Practice Location Address City Name:
FREMONT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94538-1622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-742-5795
Provider Business Practice Location Address Fax Number:
510-742-5799
Provider Enumeration Date:
09/14/2012

Additional Information

Authorized Official

Authorized Official Last Name:
FATTEH
Authorized Official First Name:
PARVEZ
Authorized Official Middle Name:
MEHBOOB
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
510-742-5795

Provider Taxonomy Codes

  • Taxonomy code: 208VP0000X , with the licence number:  A66560 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: A66560 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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