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General NPI Number Information
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NPI Number | 1427766526
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Entity Type | Individual
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Provider Name | MAHSA MONA AMELI PAC
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Gender | Female
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Dates
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Enumeration Date | 11/08/2022
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Last Update Date | 12/20/2022
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Provider Practice Location Address
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Address Line | 811 GRAND AVE STE D
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City | SACRAMENTO
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State | CA
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Zip | 95838-3466
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Country | US
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Telephone | 916-922-9868
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Fax |
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Provider Business Mailing Address
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Address Line | 5029 SOPRANO CIR
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City | FAIRFIELD
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State | CA
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Zip | 94534-6897
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Country | US
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Telephone | 310-429-3353
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 61940
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License Number State | CA
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