Healthcare Provider Details

I. General information

NPI: 1760393631
Provider Name (Legal Business Name): MOHAMMED ISSIFU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1654 DONNER WAY
WOODLAND CA
95695-5564
US

IV. Provider business mailing address

5208 HEARTLAND DR
ANTELOPE CA
95843-4621
US

V. Phone/Fax

Practice location:
  • Phone: 916-504-1951
  • Fax:
Mailing address:
  • Phone: 916-504-1951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License NumberPT43328
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: