Provider Demographics
NPI:1396037545
Name:MIRABADI, ALEX A (MD)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:A
Last Name:MIRABADI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ALIREZA
Other - Middle Name:
Other - Last Name:AGHAROKH MIRABADI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4261 DELACROIX CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95135-1722
Mailing Address - Country:US
Mailing Address - Phone:302-668-9445
Mailing Address - Fax:
Practice Address - Street 1:299 STOCKTON AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-2763
Practice Address - Country:US
Practice Address - Phone:408-535-4600
Practice Address - Fax:408-291-5952
Is Sole Proprietor?:No
Enumeration Date:2011-05-06
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA130405207QG0300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program