Healthcare Provider Details

I. General information

NPI: 1366235137
Provider Name (Legal Business Name): MUNA MOHAMED
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2025
Last Update Date: 05/26/2025
Certification Date: 05/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2634 55TH ST
SAN DIEGO CA
92105-5010
US

IV. Provider business mailing address

2634 55TH ST
SAN DIEGO CA
92105-5010
US

V. Phone/Fax

Practice location:
  • Phone: 619-431-6805
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: