MEDICARE: DR. MOHAMMAD K ARAB MD

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	207Y00000X	Otolaryngology Physician	A39192	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00A391920	OTHER	CA	BLUE SHIELD
2	00A391920	OTHER	CA	MEDI CAL

General Provider Information

NPI Number	:	1306847827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOHAMMAD K ARAB MD

Provider Business Mailing Address
First Line	:	2410 COMMERCE TRL
Second Line	:
City	:	IMPERIAL
State	:	CA
Zip	:	92251-4003
Country	:	US
Telephone Number	:	760-355-8500
Fax Number	:	760-355-8558

Provider Business Practice Location Address
First Line	:	2410 COMMERCE TRL
Second Line	:
City	:	IMPERIAL
State	:	CA
Zip	:	92251-4003
Country	:	US
Telephone Number	:	760-355-8500
Fax Number	:	760-355-8558

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	03/22/2017

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