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NPI Code Detail

MEDICARE: DR. MOHAMED ALI HASSAN GHANDOUR MD

MEDICARE: DR. MOHAMED ALI HASSAN GHANDOUR 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
1208000000XPediatrics Physician4301508826MI

General Provider Information

NPI Number : 1831683143
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MOHAMED ALI HASSAN GHANDOUR MD
Provider Business Mailing Address
First Line : 11234 ANDERSON ST
Second Line :
City : LOMA LINDA
State : CA
Zip : 92350-1716
Country : US
Telephone Number : 567-694-5980
Fax Number :
Provider Business Practice Location Address
First Line : 11234 ANDERSON ST
Second Line :
City : LOMA LINDA
State : CA
Zip : 92350-1716
Country : US
Telephone Number : 567-694-5980
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2018
Last Update Date : 01/30/2026

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