Healthcare Provider Details

I. General information

NPI: 1346590528
Provider Name (Legal Business Name): MOHAMED M ELHANAFY RRT-RCP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2012
Last Update Date: 09/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31075 QUARRY ST
MENTONE CA
92359-1516
US

IV. Provider business mailing address

31075 QUARRY ST
MENTONE CA
92359-1516
US

V. Phone/Fax

Practice location:
  • Phone: 909-825-7084
  • Fax: 909-777-3214
Mailing address:
  • Phone: 909-825-7084
  • Fax: 909-777-3214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number20294
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: