Provider Demographics
NPI:1275617771
Name:JAMNANI, BEHROUZ (MD)
Entity Type:Individual
Prefix:DR
First Name:BEHROUZ
Middle Name:
Last Name:JAMNANI
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 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:2702 LOW CT
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-9727
Practice Address - Country:US
Practice Address - Phone:707-432-2600
Practice Address - Fax:707-432-2601
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG86358208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G863580Medicaid
00G863580Medicare ID - Type Unspecified
CA00G863580Medicare PIN
CA00G863580Medicaid