Basic Information
Provider Information
NPI: 1861465940
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALAMSHAHI
FirstName: MARY
MiddleName: CHOPAN
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 10470 OLD PLACERVILLE RD
Address2: SUITE 100
City: SACRAMENTO
State: CA
PostalCode: 958272539
CountryCode: US
TelephoneNumber: 8004700071
FaxNumber:  
Practice Location
Address1: 11795 EDUCATION ST
Address2: SUITE 100
City: AUBURN
State: CA
PostalCode: 956022454
CountryCode: US
TelephoneNumber: 5308862300
FaxNumber: 5308897435
Other Information
ProviderEnumerationDate: 02/09/2006
LastUpdateDate: 10/28/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X455291CAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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