Healthcare Provider Details

I. General information

NPI: 1053295121
Provider Name (Legal Business Name): DR. AMIRA MAHMOUD SAQQA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2025
Last Update Date: 08/02/2025
Certification Date: 08/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9528 NORDMAN WAY
ELK GROVE CA
95624-4468
US

IV. Provider business mailing address

9528 NORDMAN WAY
ELK GROVE CA
95624-4468
US

V. Phone/Fax

Practice location:
  • Phone: 916-479-1036
  • Fax:
Mailing address:
  • Phone: 916-479-1036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number90928
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: