=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710791306
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NIDAL A KHALILI MD, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2025
-----------------------------------------------------
Last Update Date | 02/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7551 TIMBERLAKE WAY STE 240
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95823-5422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-681-9401
-----------------------------------------------------
Fax | 916-684-9401
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7551 TIMBERLAKE WAY STE 240
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95823-5422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-681-9401
-----------------------------------------------------
Fax | 916-684-9401
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING
-----------------------------------------------------
Name | CHARLENE M MONSON-PICOU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 916-681-9401
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------