Healthcare Provider Details

I. General information

NPI: 1578921425
Provider Name (Legal Business Name): NISSMA MAHMOUD ELDEEB KINSEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NISSMA MAHMOUD ELDEEB PA-C

II. Dates (important events)

Enumeration Date: 02/08/2016
Last Update Date: 09/02/2020
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 HOSPITAL DR
SACRAMENTO CA
95823-5403
US

IV. Provider business mailing address

7500 HOSPITAL DR
SACRAMENTO CA
95823-5477
US

V. Phone/Fax

Practice location:
  • Phone: 916-423-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number53203
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: