Provider Demographics
NPI:1750953972
Name:JAMMAL, ANTHONY GEORGE (MBA)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:GEORGE
Last Name:JAMMAL
Suffix:
Gender:M
Credentials:MBA
Other - Prefix:
Other - First Name:TONY
Other - Middle Name:GEORGE
Other - Last Name:JAMMAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MBA
Mailing Address - Street 1:735 SUNRISE AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4596
Mailing Address - Country:US
Mailing Address - Phone:530-269-8321
Mailing Address - Fax:530-269-8318
Practice Address - Street 1:735 SUNRISE AVE STE 220
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4596
Practice Address - Country:US
Practice Address - Phone:530-269-8321
Practice Address - Fax:530-269-8318
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314700004374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide