Provider Demographics
NPI:1003825175
Name:MEHRNAZ JAMALI MD INC
Entity Type:Organization
Organization Name:MEHRNAZ JAMALI MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOGHGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-335-3110
Mailing Address - Street 1:5000 PLEASANTON AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-7052
Mailing Address - Country:US
Mailing Address - Phone:858-335-3310
Mailing Address - Fax:949-831-0339
Practice Address - Street 1:5000 PLEASANTON AVE STE 110
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-7052
Practice Address - Country:US
Practice Address - Phone:925-484-4406
Practice Address - Fax:925-484-0346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-06
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53933207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFR493AOtherMEDICARE PTAN