| Doctor Name: | DR. JEFFREY ETEMAD |
| NPI Number: | 1093803983 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.O. |
| License Number: | 20A6889 |
| Business Practice Address: | 655 Redwood Hwy Suite #160 Mill Valley, CA - 949413034 |
| Business Phone Number: | 4153028254 |
| Business Fax Number: | 4154577260 |
| Mailing Address: | 655 Redwood Hwy, Suite #160 MILL VALLEY |
| State: | CA |
| Postal Code: | 949413034 |
| Phone Number: | 4153028254 |
| Fax Number: | 4154577260 |
| NPI Enumeration Date: | 10/10/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 204D00000X |
| License Number: | 20A6889 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Neuromusculoskeletal Medicine & OMM |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |