MEDICARE: RABBIA AHMED

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	363AM0700X	Medical Physician Assistant
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1902502735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RABBIA AHMED

Provider Business Mailing Address
First Line	:	835 SOUTHGROVE DR
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95133-1258
Country	:	US
Telephone Number	:	408-394-0156
Fax Number	:

Provider Business Practice Location Address
First Line	:	39141 CIVIC CENTER DR STE 205
Second Line	:
City	:	FREMONT
State	:	CA
Zip	:	94538-5823
Country	:	US
Telephone Number	:	407-306-8441
Fax Number	:

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

Provider Enumeration Date	:	02/02/2023
Last Update Date	:	11/13/2023

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Directions to “ RABBIA AHMED ” Practice Location

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