Provider Demographics
NPI:1376624858
Name:MOLLAH, MOHAMMED S (MD)
Entity Type:Individual
Prefix:MR
First Name:MOHAMMED
Middle Name:S
Last Name:MOLLAH
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 1:851 FREMONT AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024
Mailing Address - Country:US
Mailing Address - Phone:650-917-7925
Mailing Address - Fax:650-917-0104
Practice Address - Street 1:851 FREMONT AVE
Practice Address - Street 2:STE 105
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024
Practice Address - Country:US
Practice Address - Phone:650-917-7925
Practice Address - Fax:650-917-0104
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA434812084P0800X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A434810Medicaid
CAA43481OtherMEDICAL LICENSE #
CAA43481OtherMEDICAL LICENSE #
CAA43481OtherMEDICAL LICENSE #
CABM0677940OtherDEA #