Healthcare Provider Details

I. General information

NPI: 1083061865
Provider Name (Legal Business Name): FRESHTA OBAIDI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2016
Last Update Date: 07/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 29TH ST STE 480
SACRAMENTO CA
95816-5173
US

IV. Provider business mailing address

10470 OLD PLACERVILLE RD STE 100
SACRAMENTO CA
95827-2539
US

V. Phone/Fax

Practice location:
  • Phone: 916-733-3777
  • Fax: 916-454-6780
Mailing address:
  • Phone: 800-470-0071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA151402
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: