Healthcare Provider Details

I. General information

NPI: 1720630833
Provider Name (Legal Business Name): MILAD MODABBER MD, FRCSC, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2019
Last Update Date: 07/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 Y ST # 2400
SACRAMENTO CA
95817-2307
US

IV. Provider business mailing address

4860 Y ST # 2400
SACRAMENTO CA
95817-2307
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-6602
  • Fax: 916-734-6992
Mailing address:
  • Phone: 916-734-6602
  • Fax: 916-734-6992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License NumberA163509
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: