Provider Demographics
NPI:1588149199
Name:MAWLAVIZADA, FARHAT (PA-C)
Entity type:Individual
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First Name:FARHAT
Middle Name:
Last Name:MAWLAVIZADA
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:2100 POWELL ST STE 900
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-1844
Mailing Address - Country:US
Mailing Address - Phone:510-350-2832
Mailing Address - Fax:510-597-9247
Practice Address - Street 1:225 N JACKSON AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1603
Practice Address - Country:US
Practice Address - Phone:408-729-2819
Practice Address - Fax:408-928-7092
Is Sole Proprietor?:No
Enumeration Date:2018-09-28
Last Update Date:2018-10-04
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant