Healthcare Provider Details

I. General information

NPI: 1891967709
Provider Name (Legal Business Name): MOHAMMED FAROUK MAHDI PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2008
Last Update Date: 07/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2226 MEDICAL CENTER DR STE 101
PERRIS CA
92571-2657
US

IV. Provider business mailing address

1717 E LINCOLN AVE
ANAHEIM CA
92805-4345
US

V. Phone/Fax

Practice location:
  • Phone: 951-657-6559
  • Fax: 951-657-0661
Mailing address:
  • Phone: 714-635-2642
  • Fax: 714-635-8547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT28513
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: