Provider Demographics
NPI:1366683732
Name:DASTMALCHI, FIROOZEH (MD)
Entity Type:Individual
Prefix:DR
First Name:FIROOZEH
Middle Name:
Last Name:DASTMALCHI
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 1:490 POST ST
Mailing Address - Street 2:STE 900
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-1410
Mailing Address - Country:US
Mailing Address - Phone:415-362-7177
Mailing Address - Fax:415-362-8309
Practice Address - Street 1:490 POST ST STE 900
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-1410
Practice Address - Country:US
Practice Address - Phone:415-362-7177
Practice Address - Fax:154-962-1317
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-16
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301055424207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine