Provider Demographics
NPI:1407183593
Name:EL HADI MOUDERRES MD INC
Entity Type:Organization
Organization Name:EL HADI MOUDERRES MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EL HADI
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUDERRES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-236-3058
Mailing Address - Street 1:9727 ELK GROVE FLORIN RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-2291
Mailing Address - Country:US
Mailing Address - Phone:916-236-3058
Mailing Address - Fax:916-236-3061
Practice Address - Street 1:9727 ELK GROVE FLORIN RD
Practice Address - Street 2:SUITE 120
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-2291
Practice Address - Country:US
Practice Address - Phone:916-236-3058
Practice Address - Fax:916-236-3061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-10
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty