Provider Demographics
NPI:1225198351
Name:MIRZA, MUNEEZA (MD)
Entity Type:Individual
Prefix:DR
First Name:MUNEEZA
Middle Name:
Last Name:MIRZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:2030 FOREST AVE., SUITE 110
Mailing Address - Street 2:PEDIATRIC CENTER FOR LIFE
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128
Mailing Address - Country:US
Mailing Address - Phone:408-947-2929
Mailing Address - Fax:408-947-2926
Practice Address - Street 1:2030 FOREST AVE., SUITE #110
Practice Address - Street 2:PEDIATRIC CENTER FOR LIFE
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128
Practice Address - Country:US
Practice Address - Phone:408-947-2929
Practice Address - Fax:408-947-2926
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301072758208000000X
CAC53344208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4354614Medicaid
H53109Medicare UPIN