Provider Demographics
NPI:1164752242
Name:TABATABAI LLC
Entity Type:Organization
Organization Name:TABATABAI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEHER
Authorized Official - Middle Name:F
Authorized Official - Last Name:TABATABAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-405-9626
Mailing Address - Street 1:2255 CONTRA COSTA BLVD STE 305
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-3784
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2255 CONTRA COSTA BLVD STE 305
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-3784
Practice Address - Country:US
Practice Address - Phone:925-405-9626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38282207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty