Provider Demographics
NPI:1811379548
Name:FATEMI, DARIUS DARIUS (MA)
Entity Type:Individual
Prefix:MR
First Name:DARIUS
Middle Name:DARIUS
Last Name:FATEMI
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 ADDISON ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94706
Mailing Address - Country:US
Mailing Address - Phone:510-841-1262
Mailing Address - Fax:
Practice Address - Street 1:1950 ADDISON ST
Practice Address - Street 2:SUITE 109
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94706
Practice Address - Country:US
Practice Address - Phone:510-841-1262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA97330256F94218Medicare Oscar/Certification