Provider Demographics
NPI:1225053325
Name:JAMMAL, JOSEPH J (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:J
Last Name:JAMMAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MEDICAL PLAZA DR STE 250
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3050
Mailing Address - Country:US
Mailing Address - Phone:916-786-3824
Mailing Address - Fax:916-786-8036
Practice Address - Street 1:2 MEDICAL PLAZA DR STE 250
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3050
Practice Address - Country:US
Practice Address - Phone:916-786-3824
Practice Address - Fax:916-786-8036
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA035975174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist