| Prestige Med Inc | |
|
11030 Bollinger Canyon Rd Suite 240 San Ramon CA 94582-4874 | |
| (925) 736-1000 | |
| (925) 736-1055 |
| Full Name | Prestige Med Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 11030 Bollinger Canyon Rd, San Ramon, California |
| Authorized Official Name and Position | Joseph Y Mardanzai (OWNER) |
| Authorized Official Contact | 9257361000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prestige Med Inc 11030 Bollinger Canyon Rd Suite 240 San Ramon CA 94582-4874 Ph: (925) 736-1000 | Prestige Med Inc 11030 Bollinger Canyon Rd Suite 240 San Ramon CA 94582-4874 Ph: (925) 736-1000 |
| NPI Number | 1477968741 |
|---|---|
| Provider Enumeration Date | 06/25/2014 |
| Last Update Date | 06/25/2014 |
| Medicare PECOS PAC ID | 4284899949 |
|---|---|
| Medicare Enrollment ID | O20120702000130 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477968741 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | A80856 (California) | Primary |
| Provider Name | Joseph Yusaf Mardanzai |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1043220031 PECOS PAC ID: 7911916382 Enrollment ID: I20060412000403 |
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