MEDICARE: MEENA MEDICAL GROUP, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	A111390	CA

General Provider Information

NPI Number	:	1710348321
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEENA MEDICAL GROUP, INC

Provider Business Mailing Address
First Line	:	1600 CREEKSIDE DR STE 2100
Second Line	:
City	:	FOLSOM
State	:	CA
Zip	:	95630-3447
Country	:	US
Telephone Number	:	916-542-7467
Fax Number	:	916-932-4879

Provider Business Practice Location Address
First Line	:	1600 CREEKSIDE DR STE 2100
Second Line	:
City	:	FOLSOM
State	:	CA
Zip	:	95630-3447
Country	:	US
Telephone Number	:	916-542-7467
Fax Number	:	916-932-4879

Authorized Official
Title or Position	:	CEO
Name	:	DR. QAIS M WAHIDI
Credential	:	MD
Telephone Number	:	916-542-7467

Provider Enumeration Date	:	03/09/2016
Last Update Date	:	10/03/2024

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