Healthcare Provider Details

I. General information

NPI: 1285106930
Provider Name (Legal Business Name): MOHAMMED BADREDDINE SMATI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2018
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1704 MIRAMONTE AVE STE 3
MOUNTAIN VIEW CA
94040-3718
US

IV. Provider business mailing address

1704 MIRAMONTE AVE STE 3
MOUNTAIN VIEW CA
94040-3718
US

V. Phone/Fax

Practice location:
  • Phone: 650-930-9550
  • Fax:
Mailing address:
  • Phone: 650-930-9550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: