Healthcare Provider Details

I. General information

NPI: 1578488375
Provider Name (Legal Business Name): MOHAMMAD ADILI CDR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 CRESTA WAY APT 5
SAN RAFAEL CA
94903-4869
US

IV. Provider business mailing address

1055 CRESTA WAY APT 5
SAN RAFAEL CA
94903-4869
US

V. Phone/Fax

Practice location:
  • Phone: 916-718-2689
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86209979
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: