Healthcare Provider Details

I. General information

NPI: 1134869662
Provider Name (Legal Business Name): MURTAZA MASROOR KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 STOCKTON BLVD RM 202
SACRAMENTO CA
95817-1353
US

IV. Provider business mailing address

44578 COUNTRY CLUB DR
EL MACERO CA
95618-1046
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-2011
  • Fax:
Mailing address:
  • Phone: 530-400-7230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: