Healthcare Provider Details

I. General information

NPI: 1134997471
Provider Name (Legal Business Name): KHAKWANI AND MOHAMMAD MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2023
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13869 W BELL RD STE 103B
SURPRISE AZ
85374-2468
US

IV. Provider business mailing address

PO BOX 660047
DALLAS TX
75266-2900
US

V. Phone/Fax

Practice location:
  • Phone: 623-600-4466
  • Fax: 623-748-6440
Mailing address:
  • Phone: 702-820-5713
  • Fax: 702-820-5713

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 Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: VALERIE DENISE ESTRADA
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 469-718-2768