Healthcare Provider Details

I. General information

NPI: 1770011561
Provider Name (Legal Business Name): FATMEH A JOBAY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2017
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 SUNRISE BLVD STE 130
RANCHO CORDOVA CA
95742
US

IV. Provider business mailing address

PO BOX 255228
SACRAMENTO CA
95865-5228
US

V. Phone/Fax

Practice location:
  • Phone: 800-972-5547
  • Fax: 916-887-7507
Mailing address:
  • Phone: 800-470-0071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95006644
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: