Provider Demographics
NPI:1710348321
Name:MEENA MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:MEENA MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:QAIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:WAHIDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-542-7467
Mailing Address - Street 1:1600 CREEKSIDE DR
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3444
Mailing Address - Country:US
Mailing Address - Phone:916-542-7467
Mailing Address - Fax:916-932-4879
Practice Address - Street 1:1600 CREEKSIDE DR
Practice Address - Street 2:SUITE 2300
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3444
Practice Address - Country:US
Practice Address - Phone:916-542-7467
Practice Address - Fax:916-932-4879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA111390261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care