Provider Demographics
NPI:1750714077
Name:MIRAMONTE INTERNAL MEDICINE, INC.
Entity type:Organization
Organization Name:MIRAMONTE INTERNAL MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PRADIP
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:RUSTAGI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-988-8011
Mailing Address - Street 1:1174 CASTRO ST
Mailing Address - Street 2:SUITE 275
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-2568
Mailing Address - Country:US
Mailing Address - Phone:650-988-8011
Mailing Address - Fax:650-988-8012
Practice Address - Street 1:1174 CASTRO ST
Practice Address - Street 2:SUITE 275
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-2568
Practice Address - Country:US
Practice Address - Phone:650-988-8011
Practice Address - Fax:650-988-8012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83670207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty