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General NPI Number Information
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NPI Number | 1457825697
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Entity Type | Individual
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Provider Name | NIVIN M MOHEIELDIN
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Gender | Female
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Dates
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Enumeration Date | 01/21/2019
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Last Update Date | 08/11/2020
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Provider Practice Location Address
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Address Line | 902 E HAMMER LN
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City | STOCKTON
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State | CA
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Zip | 95210-3027
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Country | US
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Telephone | 669-220-0464
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Fax |
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Provider Business Mailing Address
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Address Line | 11090 MOUNTAIN VIEW DR APT 62
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-8914
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Country | US
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Telephone | 669-220-0464
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 103486
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License Number State | CA
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