Provider Demographics
NPI:1477333912
Name:MDSTX MED SPA PC
Entity Type:Organization
Organization Name:MDSTX MED SPA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ZESHAAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-656-9404
Mailing Address - Street 1:5700 VILLAGE OAKS DR STE 30
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-3768
Mailing Address - Country:US
Mailing Address - Phone:408-656-9404
Mailing Address - Fax:
Practice Address - Street 1:5700 VILLAGE OAKS DR STE 30
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-3768
Practice Address - Country:US
Practice Address - Phone:408-656-9404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center