Healthcare Provider Details

I. General information

NPI: 1215477849
Provider Name (Legal Business Name): LEYLA MOHAMED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2017
Last Update Date: 03/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26471 CALLE ROLANDO
SAN JUAN CAPISTRANO CA
92675-4183
US

IV. Provider business mailing address

3972 BARRANCA PKWY STE. J250
IRVINE CA
92606-1204
US

V. Phone/Fax

Practice location:
  • Phone: 949-748-9886
  • Fax:
Mailing address:
  • Phone:
  • 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: