Healthcare Provider Details

I. General information

NPI: 1477343366
Provider Name (Legal Business Name): HYDRALUX WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 05/12/2025
Certification Date: 05/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 JULIA ISLAND CIR
SACRAMENTO CA
95834-7762
US

IV. Provider business mailing address

189 JULIA ISLAND CIR
SACRAMENTO CA
95834-7762
US

V. Phone/Fax

Practice location:
  • Phone: 213-273-4415
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MOHAMMADREZA JAFARISHOURIJEH
Title or Position: CEO
Credential:
Phone: 213-273-4415