Healthcare Provider Details

I. General information

NPI: 1902289515
Provider Name (Legal Business Name): MOHAMMAD A TABEK BAKIR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2015
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 N 3RD ST
LOMPOC CA
93436-7099
US

IV. Provider business mailing address

136 N 3RD ST
LOMPOC CA
93436-7002
US

V. Phone/Fax

Practice location:
  • Phone: 805-736-1253
  • Fax: 805-736-5355
Mailing address:
  • Phone: 805-736-1253
  • Fax: 805-736-5355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA153458
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: