Healthcare Provider Details

I. General information

NPI: 1467776096
Provider Name (Legal Business Name): HAMIDA KHANMOHAMMED NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2010
Last Update Date: 03/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

393 EAST WALNUT STREET, PASADENA, CA 91188 SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP
PASADENA CA
91188
US

IV. Provider business mailing address

SOUTHER CALIFORNIA PERMENTE 393 EAST WALNUT STREET
PASADENA CA
91188-0001
US

V. Phone/Fax

Practice location:
  • Phone: 626-405-3224
  • Fax:
Mailing address:
  • Phone: 626-405-3224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number19597
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: