MEDICARE: DR. NAMITA P. MOHIDEEN M.D.

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	208000000X	Pediatrics Physician	A55769	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	ZZZ39356Z	OTHER	CA	BS/TRIWEST
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	ZZZ01339Z	OTHER	CA	BS/TRIWEST
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871543850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NAMITA P. MOHIDEEN M.D.

Provider Business Mailing Address
First Line	:	16465 SIERRA LAKES PKWY STE 115
Second Line	:
City	:	FONTANA
State	:	CA
Zip	:	92336-1242
Country	:	US
Telephone Number	:	909-823-8000
Fax Number	:	909-823-8088

Provider Business Practice Location Address
First Line	:	16465 SIERRA LAKES PKWY STE 115
Second Line	:
City	:	FONTANA
State	:	CA
Zip	:	92336-1242
Country	:	US
Telephone Number	:	909-823-8000
Fax Number	:	909-823-8088

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	05/16/2025

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Directions to “ DR. NAMITA P. MOHIDEEN M.D.” Practice Location

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