Provider Demographics
NPI:1821278169
Name:HAJERA SULTANA MD., INC
Entity Type:Organization
Organization Name:HAJERA SULTANA MD., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAJERA
Authorized Official - Middle Name:
Authorized Official - Last Name:SULTANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-283-4725
Mailing Address - Street 1:3838 SHERMAN DR
Mailing Address - Street 2:STE 12
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-4001
Mailing Address - Country:US
Mailing Address - Phone:951-351-9994
Mailing Address - Fax:951-351-2394
Practice Address - Street 1:3838 SHERMAN DR
Practice Address - Street 2:STE 12
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-4001
Practice Address - Country:US
Practice Address - Phone:951-351-9994
Practice Address - Fax:951-351-2394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-04
Last Update Date:2007-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78589207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1063537306OtherINDIVIDUAL NPI NUMBER
CAOOA785890Medicaid
CAH92466Medicare UPIN
CAOOA785890Medicaid