Provider Demographics
NPI:1972644797
Name:MORTEZA DOWLATSHAHI M D INC
Entity type:Organization
Organization Name:MORTEZA DOWLATSHAHI M D INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MORTEZA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOWLATSHAHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-729-4673
Mailing Address - Street 1:PO BOX 743095
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-3095
Mailing Address - Country:US
Mailing Address - Phone:408-729-4673
Mailing Address - Fax:408-729-9943
Practice Address - Street 1:200 JOSE FIGUERES AVE
Practice Address - Street 2:SUITE 199
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1500
Practice Address - Country:US
Practice Address - Phone:408-729-4673
Practice Address - Fax:408-729-9943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ22680ZMedicare PIN