Healthcare Provider Details

I. General information

NPI: 1063817823
Provider Name (Legal Business Name): ENARA HEALTH GROUP, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2014
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 S DELAWARE ST STE 130
SAN MATEO CA
94403-2394
US

IV. Provider business mailing address

3050 S DELAWARE ST STE 130
SAN MATEO CA
94403-2394
US

V. Phone/Fax

Practice location:
  • Phone: 650-319-8654
  • Fax:
Mailing address:
  • Phone: 650-319-8654
  • Fax: 650-251-4999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MOHAMMED RAMI BAILONY
Title or Position: MEDICAL DIRECTOR
Credential: M.D
Phone: 619-807-2861