Provider Demographics
NPI:1255452793
Name:PARVEZ FATTEH, M.D. A MEDICAL CORPORATION
Entity type:Organization
Organization Name:PARVEZ FATTEH, M.D. A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PARVEZ
Authorized Official - Middle Name:
Authorized Official - Last Name:FATTEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-265-5795
Mailing Address - Street 1:24301 SOUTHLAND DR STE 411
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-1551
Mailing Address - Country:US
Mailing Address - Phone:510-265-5795
Mailing Address - Fax:510-732-5461
Practice Address - Street 1:24301 SOUTHLAND DR STE 411
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-1551
Practice Address - Country:US
Practice Address - Phone:510-265-5795
Practice Address - Fax:510-732-5461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2007-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66560174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA66560OtherMD LIC #
CAA66560OtherMD LIC #