MEDICARE: ABDELHAMEED YAQOUB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172A00000X	Driver	560174	AZ

General Provider Information

NPI Number	:	1083959217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABDELHAMEED YAQOUB

Provider Business Mailing Address
First Line	:	11225 N 28TH DR STE C207
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85029-5600
Country	:	US
Telephone Number	:	602-367-7916
Fax Number	:	602-367-7916

Provider Business Practice Location Address
First Line	:	11225 N 28TH DR STE C207
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85029-5600
Country	:	US
Telephone Number	:	602-367-7916
Fax Number	:	602-997-1552

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2012
Last Update Date	:	06/10/2019

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Directions to “ ABDELHAMEED YAQOUB ” Practice Location

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