Provider Demographics
NPI:1437112158
Name:DOWLATSHAHI, MORTEZA (MD)
Entity Type:Individual
Prefix:DR
First Name:MORTEZA
Middle Name:
Last Name:DOWLATSHAHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 JOSE FIGUERES AVE
Mailing Address - Street 2:SUITE 199
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1588
Mailing Address - Country:US
Mailing Address - Phone:408-729-4673
Mailing Address - Fax:408-729-7043
Practice Address - Street 1:200 JOSE FIGUERES AVE
Practice Address - Street 2:SUITE 199
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1500
Practice Address - Country:US
Practice Address - Phone:408-729-4673
Practice Address - Fax:408-729-7043
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA552562085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH08406Medicare UPIN
CA00A552560Medicare PIN