Healthcare Provider Details

I. General information

NPI: 1386160653
Provider Name (Legal Business Name): MOHAMMED UMER ABDUL WARIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: UMER ABDUL WARIS

II. Dates (important events)

Enumeration Date: 08/18/2017
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 HIGHLAND POINTE DR STE 250
ROSEVILLE CA
95678-5421
US

IV. Provider business mailing address

915 HIGHLAND POINTE DR STE 250
ROSEVILLE CA
95678-5421
US

V. Phone/Fax

Practice location:
  • Phone: 916-252-5707
  • Fax: 916-269-0196
Mailing address:
  • Phone: 916-252-5707
  • Fax: 916-269-0196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA184414
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: