Healthcare Provider Details

I. General information

NPI: 1861202335
Provider Name (Legal Business Name): UMBRELLA MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2025
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1728 W GLENDALE AVE STE 100
PHOENIX AZ
85021-8862
US

IV. Provider business mailing address

7142 N 17TH DR
PHOENIX AZ
85021-8539
US

V. Phone/Fax

Practice location:
  • Phone: 623-299-8251
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MOHAMED KHALIL
Title or Position: CEO
Credential:
Phone: 602-369-1823