Provider Demographics
NPI:1902859416
Name:ALGHANNAM, MUHAMMAD (MD)
Entity Type:Individual
Prefix:MR
First Name:MUHAMMAD
Middle Name:
Last Name:ALGHANNAM
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 1:1528 PLUMAS CT STE 100
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-2973
Mailing Address - Country:US
Mailing Address - Phone:530-763-4104
Mailing Address - Fax:530-434-6798
Practice Address - Street 1:1528 PLUMAS CT STE 100
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-2973
Practice Address - Country:US
Practice Address - Phone:530-763-4104
Practice Address - Fax:530-434-6798
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2020-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78203208VP0000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A782030OtherBLUE SHIELD PIN #
CA1902859416Medicaid
CA1902859416Medicaid
H61673Medicare UPIN