Healthcare Provider Details

I. General information

NPI: 1508536657
Provider Name (Legal Business Name): MOHAMMED AFIEF AFZAL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2021
Last Update Date: 09/20/2021
Certification Date: 09/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 E FAIRMONT AVE
MODESTO CA
95350-6074
US

IV. Provider business mailing address

817 E FAIRMONT AVE
MODESTO CA
95350-6074
US

V. Phone/Fax

Practice location:
  • Phone: 209-247-8511
  • Fax:
Mailing address:
  • Phone: 209-247-8511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: