Provider Demographics
NPI:1003995135
Name:JAMALI, FARNAZ FAYE (MD)
Entity Type:Individual
Prefix:
First Name:FARNAZ
Middle Name:FAYE
Last Name:JAMALI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 E BLITHEDALE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-2092
Mailing Address - Country:US
Mailing Address - Phone:415-887-8718
Mailing Address - Fax:
Practice Address - Street 1:250 E BLITHEDALE AVE STE B
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2092
Practice Address - Country:US
Practice Address - Phone:415-887-8718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81063208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G810630Medicaid
00G810630Medicare ID - Type Unspecified
G93156Medicare UPIN