Provider Demographics
NPI:1013734359
Name:BADDAWI, MOHAMMAD SALEH
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:SALEH
Last Name:BADDAWI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 WOODHAVEN CIR
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-4615
Mailing Address - Country:US
Mailing Address - Phone:916-865-8692
Mailing Address - Fax:
Practice Address - Street 1:1708 WOODHAVEN CIR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-4615
Practice Address - Country:US
Practice Address - Phone:916-865-8692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00852244172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty