Provider Demographics
NPI:1649546144
Name:NAMITA MOHIDEEN MD INC
Entity type:Organization
Organization Name:NAMITA MOHIDEEN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NAMITA
Authorized Official - Middle Name:PANDIRI
Authorized Official - Last Name:MOHIDEEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-823-8000
Mailing Address - Street 1:16465 SIERRA LAKES PKWY STE 115
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-1242
Mailing Address - Country:US
Mailing Address - Phone:909-823-8000
Mailing Address - Fax:909-823-8088
Practice Address - Street 1:16465 SIERRA LAKES PKWY STE 115
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-1242
Practice Address - Country:US
Practice Address - Phone:909-823-8000
Practice Address - Fax:909-823-8088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-29
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55769261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care