Provider Demographics
NPI:1447354733
Name:MOJADADDI, SOHAILA M (MD)
Entity type:Individual
Prefix:
First Name:SOHAILA
Middle Name:M
Last Name:MOJADADDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 E ALMOND AVE STE B
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-5641
Mailing Address - Country:US
Mailing Address - Phone:559-661-1100
Mailing Address - Fax:559-661-1107
Practice Address - Street 1:550 E ALMOND AVE STE B
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-5641
Practice Address - Country:US
Practice Address - Phone:559-661-1100
Practice Address - Fax:559-661-1107
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A454510207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A454510Medicaid
00A454510Medicare ID - Type Unspecified
CA00A454510Medicaid