Organization
FORTANI MEDICAL CORP.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARYAM FORTANI M.D. (PRESIDENT)
(925) 202-1888
Entity
Organization
Contact information
Practice address
13847 E 14TH ST, SUITE 216, SAN LEANDRO, CA 94578-2632
(510) 357-3023
Mailing address
3255 GULFSTREAM ST, PLEASANTON, CA 94588-3525
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
A 82319
CA
Other
Enumeration date
08/15/2011
Last updated
03/05/2012
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