Provider Demographics
NPI:1427784842
Name:MUKHTAR, AMEEN SULAIMAN
Entity type:Individual
Prefix:
First Name:AMEEN
Middle Name:SULAIMAN
Last Name:MUKHTAR
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 1:234 LAKERIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-4821
Mailing Address - Country:US
Mailing Address - Phone:925-209-1611
Mailing Address - Fax:
Practice Address - Street 1:234 LAKERIDGE WAY
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94582-4821
Practice Address - Country:US
Practice Address - Phone:925-209-1611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator