| Meena Medical Group, Inc | |
|
1600 Creekside Dr Ste 2100 Folsom CA 95630-3447 | |
| (916) 542-7467 | |
| (916) 932-4879 |
| Full Name | Meena Medical Group, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1600 Creekside Dr Ste 2100, Folsom, California |
| Authorized Official Name and Position | Qais M Wahidi (CEO) |
| Authorized Official Contact | 9165427467 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Meena Medical Group, Inc 1600 Creekside Dr Ste 2100 Folsom CA 95630-3447 Ph: (916) 542-7467 | Meena Medical Group, Inc 1600 Creekside Dr Ste 2100 Folsom CA 95630-3447 Ph: (916) 542-7467 |
| NPI Number | 1710348321 |
|---|---|
| Provider Enumeration Date | 03/09/2016 |
| Last Update Date | 10/03/2024 |
| Medicare PECOS PAC ID | 1658679873 |
|---|---|
| Medicare Enrollment ID | O20160420002411 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710348321 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | A111390 (California) | Primary |
| Provider Name | Qais M Wahidi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1699931097 PECOS PAC ID: 1658403753 Enrollment ID: I20100723000839 |
| Provider Name | Sean Koulaboud |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568837276 PECOS PAC ID: 0143527671 Enrollment ID: I20170505002072 |
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