Provider Demographics
NPI:1740670090
Name:NAYYARA DAWOOD M.D. PEDIATRICS CORP.
Entity type:Organization
Organization Name:NAYYARA DAWOOD M.D. PEDIATRICS CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT /CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NAYYARA
Authorized Official - Middle Name:SULTANA
Authorized Official - Last Name:DAWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-373-9742
Mailing Address - Street 1:275, O' CONNOR DRIVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1657
Mailing Address - Country:US
Mailing Address - Phone:408-279-8786
Mailing Address - Fax:408-279-3941
Practice Address - Street 1:275, O'CONNOR DRIVE
Practice Address - Street 2:SUITE C
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1657
Practice Address - Country:US
Practice Address - Phone:408-279-8786
Practice Address - Fax:408-279-3941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63743261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A637430Medicaid