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Organization
PRESTIGE MED INC
Active
Organization
PRESTIGE MED INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH Y MARDANZAI MD (OWNER)
(925) 718-6622
Entity
Organization
Contact information
Practice address
11030 BOLLINGER CANYON RD, STE 240, SAN RAMON, CA 94582-4874
(925) 718-6622
(201) 690-8632
Mailing address
PO BOX 3888, SAN RAMON, CA 94583-8888
(925) 718-6622
(201) 690-8632
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
A80856
CA
208M00000X
Hospitalist Physician
A80856
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GF086A
MEDICARE PTAN
CA
Enumeration date
05/21/2012
Last updated
11/12/2015
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