Provider Demographics
NPI:1801196605
Name:MOHAMMAD, GULPANA M (MD)
Entity Type:Individual
Prefix:
First Name:GULPANA
Middle Name:M
Last Name:MOHAMMAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GULPANA
Other - Middle Name:M
Other - Last Name:ANSARI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:PHYSICIAN SUPPORT SERVICES - 2ND FL
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1301 SHOREWAY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002
Practice Address - Country:US
Practice Address - Phone:650-596-7000
Practice Address - Fax:650-596-7096
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-26
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA114460207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine