Healthcare Provider Details

I. General information

NPI: 1508771577
Provider Name (Legal Business Name): IBNE SINA COMMUNITY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2026
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12882 N LOWER SACRAMENTO RD
LODI CA
95242-9225
US

IV. Provider business mailing address

1112 RIVERGATE DR
LODI CA
95240-0555
US

V. Phone/Fax

Practice location:
  • Phone: 209-200-3314
  • Fax:
Mailing address:
  • Phone: 209-663-0453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SAMINA QAMAR
Title or Position: PRESIDENT
Credential: MD
Phone: 209-715-7888