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General NPI Number Information
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NPI Number | 1477114791
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Entity Type | Individual
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Provider Name | JAVID MAHMOODI MD
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Gender | Male
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Dates
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Enumeration Date | 06/26/2019
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 1201 ALHAMBRA BLVD STE 400
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City | SACRAMENTO
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State | CA
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Zip | 95816-5243
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Country | US
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Telephone | 916-733-5090
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Fax | 916-733-9814
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Provider Business Mailing Address
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Address Line | PO BOX 255228
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City | SACRAMENTO
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State | CA
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Zip | 95865-5228
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Country | US
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Telephone |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | PTL6606
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A181525
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License Number State | CA
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