Provider Demographics
NPI:1871469668
Name:KARIM MOUKADDAM
Entity type:Organization
Organization Name:KARIM MOUKADDAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KARIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUKADDAM
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN
Authorized Official - Phone:719-310-3689
Mailing Address - Street 1:6637 VALLEY HI DR APT 374
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-7033
Mailing Address - Country:US
Mailing Address - Phone:719-310-3689
Mailing Address - Fax:
Practice Address - Street 1:3102 O ST STE 5
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-6544
Practice Address - Country:US
Practice Address - Phone:719-310-3689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-16
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty