Healthcare Provider Details

I. General information

NPI: 1801162623
Provider Name (Legal Business Name): NAEEM MARKARM GOUSSOUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2012
Last Update Date: 06/29/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 V STREET SUITE 2212
SACRAMENTO CA
95817
US

IV. Provider business mailing address

2335 STOCKTON BLVD NAOB 6TH FLOOR
SACRAMENTO CA
95817
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-7293
  • Fax: 916-734-6564
Mailing address:
  • Phone: 916-734-7293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License NumberA170464
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: