Provider Demographics
NPI:1669051116
Name:AHMED, PALWASHA (DPM)
Entity type:Individual
Prefix:
First Name:PALWASHA
Middle Name:
Last Name:AHMED
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2089 VALE RD STE 12
Mailing Address - Street 2:
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-3848
Mailing Address - Country:US
Mailing Address - Phone:510-232-0892
Mailing Address - Fax:510-234-5951
Practice Address - Street 1:3000 COLBY ST STE 107
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2090
Practice Address - Country:US
Practice Address - Phone:510-647-3567
Practice Address - Fax:510-234-5951
Is Sole Proprietor?:No
Enumeration Date:2021-04-02
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE6052213E00000X
IL135.001136213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist