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NPI Code Detail

MEDICARE: ABDALLA MOHAMED FATHALLA SHOAIB

MEDICARE: ABDALLA MOHAMED FATHALLA SHOAIB
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
1390200000XStudent in an Organized Health Care Education/Training ProgramCA

General Provider Information

NPI Number : 1619817145
Entity Type Code : Individual
Provider Name (Legal Business Name) : ABDALLA MOHAMED FATHALLA SHOAIB
Provider Business Mailing Address
First Line : 730 1ST ST SW # 730
Second Line :
City : ROCHESTER
State : MN
Zip : 55902-6292
Country : US
Telephone Number : 913-225-0990
Fax Number :
Provider Business Practice Location Address
First Line : 500 W HOSPITAL RD
Second Line :
City : FRENCH CAMP
State : CA
Zip : 95231-9693
Country : US
Telephone Number : 209-468-6624
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2026
Last Update Date : 04/01/2026

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Directions to “ ABDALLA MOHAMED FATHALLA SHOAIB ” Practice Location

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