# MADINA HOUSE CLINIC INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639951338
- **Authorized official:** DR. AMER SYED RAHEEMULLAH MD (MEDICAL DIRECTOR/PRESIDENT)
- **Authorized official phone:** (510) 902-7080

## Contact information

- **Practice address:** 43575 MISSION BLVD \# 1019, FREMONT, CA 94539-5831
- **Practice address phone:** (510) 902-7080
- **Mailing address:** 43575 MISSION BLVD \# 1019, FREMONT, CA 94539-5831
- **Mailing address phone:** (510) 902-7080

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician | — | NULL | Yes |
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician | — | — | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 10/17/2023
- **Last updated:** 04/08/2024