Provider Demographics
NPI:1922409259
Name:MOHAMMAD, SUNNAA SOMUN
Entity Type:Individual
Prefix:
First Name:SUNNAA
Middle Name:SOMUN
Last Name:MOHAMMAD
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 1:2348 BYRD DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-3956
Mailing Address - Country:US
Mailing Address - Phone:714-393-3038
Mailing Address - Fax:
Practice Address - Street 1:3330 CAMERON PARK DR
Practice Address - Street 2:
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-8861
Practice Address - Country:US
Practice Address - Phone:916-587-1002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-05
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW68601101YM0800X
CALCSW870241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health