Provider Demographics
NPI:1740806306
Name:PREVENTATIVE MEDICINE INC
Entity Type:Organization
Organization Name:PREVENTATIVE MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEPIDEH
Authorized Official - Middle Name:
Authorized Official - Last Name:MOAYED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-383-7679
Mailing Address - Street 1:27200 CARRINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-4300
Mailing Address - Country:US
Mailing Address - Phone:650-400-9868
Mailing Address - Fax:
Practice Address - Street 1:2242 CAMDEN AVE STE 203
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-2029
Practice Address - Country:US
Practice Address - Phone:408-796-7483
Practice Address - Fax:408-796-7492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction MedicineGroup - Single Specialty