1740670090 NPI number — NAYYARA DAWOOD M.D. PEDIATRICS CORP.

Table of content: (NPI 1740670090)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740670090 NPI number — NAYYARA DAWOOD M.D. PEDIATRICS CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NAYYARA DAWOOD M.D. PEDIATRICS CORP.
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:
1740670090
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
275, O' CONNOR DRIVE
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95128-1657
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-279-8786
Provider Business Mailing Address Fax Number:
408-279-3941

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
275, O'CONNOR DRIVE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95128-1657
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-279-8786
Provider Business Practice Location Address Fax Number:
408-279-3941
Provider Enumeration Date:
01/26/2015

Additional Information

Authorized Official

Authorized Official Last Name:
DAWOOD
Authorized Official First Name:
NAYYARA
Authorized Official Middle Name:
SULTANA
Authorized Official Title or Position:
PRESIDENT /CEO
Authorized Official Telephone Number:
408-373-9742

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  A63743 , 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: 00A637430 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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