Healthcare Provider Details

I. General information

NPI: 1316506629
Provider Name (Legal Business Name): MARYAM MARGARET MOSLEMI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 29TH ST STE 600
SACRAMENTO CA
95816-5126
US

IV. Provider business mailing address

PO BOX 255228
SACRAMENTO CA
95865-5228
US

V. Phone/Fax

Practice location:
  • Phone: 916-733-9588
  • Fax: 916-733-9593
Mailing address:
  • Phone: 800-470-0071
  • Fax: 916-854-6769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA57527
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: