Healthcare Provider Details

I. General information

NPI: 1447413802
Provider Name (Legal Business Name): HESHAM ATTAYA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3161 L ST
SACRAMENTO CA
95816-5234
US

IV. Provider business mailing address

PO BOX 276950
SACRAMENTO CA
95827-6950
US

V. Phone/Fax

Practice location:
  • Phone: 916-878-3495
  • Fax:
Mailing address:
  • Phone: 916-878-3495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA144016
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number123859
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: