Provider Demographics
NPI:1720577091
Name:ABDELKADIR, JIMELA KRYSTAL
Entity Type:Individual
Prefix:
First Name:JIMELA
Middle Name:KRYSTAL
Last Name:ABDELKADIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 DUCKHORN DR APT 635
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-1079
Mailing Address - Country:US
Mailing Address - Phone:553-216-8311
Mailing Address - Fax:
Practice Address - Street 1:1050 FULTON AVE STE 35
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-4272
Practice Address - Country:US
Practice Address - Phone:916-974-2599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician