Basic Information
| Provider Information | |||||||||
| NPI: | 1124654348 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JAANEALI MEHDI MD INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 220 STANDIFORD AVE STE F | ||||||||
| Address2: | |||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953501159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095795628 | ||||||||
| FaxNumber: | 2095795637 | ||||||||
| Practice Location | |||||||||
| Address1: | 1501 CLAUS RD | ||||||||
| Address2: | |||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953559711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095576310 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2020 | ||||||||
| LastUpdateDate: | 09/30/2020 | ||||||||
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| AuthorizedOfficialLastName: | MEHDI | ||||||||
| AuthorizedOfficialFirstName: | JAANEALI | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6069392621 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 09/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | C156559 | 01 | CA | STATE OF CA MEDICAL BOARD | OTHER |