=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174342554
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEENA MEDICAL GROUP, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2024
-----------------------------------------------------
Last Update Date | 10/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3939 J ST STE 370
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95819-3671
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-453-2800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3939 J ST STE 370
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95819-3671
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-453-2800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER/ OWNER
-----------------------------------------------------
Name | HASMA WAHIDI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 916-983-2663
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------