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General NPI Number Information
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NPI Number | 1639951338
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Entity Type | Organization
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Legal Business Name | MADINA HOUSE CLINIC INC
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Dates
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Enumeration Date | 10/17/2023
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Last Update Date | 04/08/2024
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Provider Practice Location Address
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Address Line | 43575 MISSION BLVD # 1019
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City | FREMONT
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State | CA
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Zip | 94539-5831
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Country | US
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Telephone | 510-902-7080
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Fax |
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Provider Business Mailing Address
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Address Line | 43575 MISSION BLVD # 1019
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City | FREMONT
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State | CA
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Zip | 94539-5831
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Country | US
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Telephone | 510-902-7080
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR/PRESIDENT
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Name | DR. AMER SYED RAHEEMULLAH
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Credential | MD
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Telephone | 510-902-7080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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