Healthcare Provider Details

I. General information

NPI: 1992403901
Provider Name (Legal Business Name): AZAAM MAMOOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9700 W TARON DR
ELK GROVE CA
95757-8145
US

IV. Provider business mailing address

9300 W SUNSET RD
LAS VEGAS NV
89148
US

V. Phone/Fax

Practice location:
  • Phone: 916-686-7300
  • Fax:
Mailing address:
  • Phone: 702-916-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberLL3990
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: