Provider Demographics
NPI:1730106626
Name:MOUDERRES, EL-HADI (MD)
Entity Type:Individual
Prefix:
First Name:EL-HADI
Middle Name:
Last Name:MOUDERRES
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 1:7601 HOSPITAL DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-5408
Mailing Address - Country:US
Mailing Address - Phone:916-681-9401
Mailing Address - Fax:916-681-9417
Practice Address - Street 1:7601 HOSPITAL DR
Practice Address - Street 2:SUITE 201
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-5408
Practice Address - Country:US
Practice Address - Phone:916-681-9401
Practice Address - Fax:916-681-9417
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC537782084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN390464400Medicaid
H98642Medicare UPIN
MN390464400Medicaid