Healthcare Provider Details

I. General information

NPI: 1164280921
Provider Name (Legal Business Name): MS. FATMA OMAR AHMED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: FATUMA AHMED

II. Dates (important events)

Enumeration Date: 03/07/2024
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4707 W PALMAIRE AVE
GLENDALE AZ
85301-2723
US

IV. Provider business mailing address

4707 W PALMAIRE AVE
GLENDALE AZ
85301-2723
US

V. Phone/Fax

Practice location:
  • Phone: 480-388-4935
  • Fax:
Mailing address:
  • Phone: 480-388-4935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: