Healthcare Provider Details

I. General information

NPI: 1235990060
Provider Name (Legal Business Name): JAMAL MUJADDID MOHAMMED, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2024
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1996 DEL PASO RD STE 176
SACRAMENTO CA
95834-7731
US

IV. Provider business mailing address

412 HERKIMER ST APT 7E
BROOKLYN NY
11213-1629
US

V. Phone/Fax

Practice location:
  • Phone: 916-793-0947
  • Fax:
Mailing address:
  • Phone: 832-488-5529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMAL MUJADDID MOHAMMED
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MD
Phone: 916-793-0947