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NPI Code Detail

MEDICARE: MR. BRIMA SIDIANQUE MIKAILU JAH JR. MFT

MEDICARE: MR. BRIMA SIDIANQUE MIKAILU JAH JR. MFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist136300CA

General Provider Information

NPI Number : 1285788901
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRIMA SIDIANQUE MIKAILU JAH JR. MFT
Provider Business Mailing Address
First Line : 4337 NORWOOD AVE # 141
Second Line :
City : SACRAMENTO
State : CA
Zip : 95838-2615
Country : US
Telephone Number : 510-332-8864
Fax Number :
Provider Business Practice Location Address
First Line : 1820 J ST
Second Line :
City : SACRAMENTO
State : CA
Zip : 95811-3010
Country : US
Telephone Number : 916-737-5555
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2007
Last Update Date : 06/04/2024

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