Provider Demographics
NPI:1720630833
Name:MODABBER, MILAD (MD, FRCSC, MS)
Entity Type:Individual
Prefix:DR
First Name:MILAD
Middle Name:
Last Name:MODABBER
Suffix:
Gender:M
Credentials:MD, FRCSC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4860 Y ST # 2400
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2307
Mailing Address - Country:US
Mailing Address - Phone:916-734-6602
Mailing Address - Fax:916-734-6992
Practice Address - Street 1:4860 Y ST # 2400
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2307
Practice Address - Country:US
Practice Address - Phone:916-734-6602
Practice Address - Fax:916-734-6992
Is Sole Proprietor?:No
Enumeration Date:2019-07-10
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA163509207WX0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist