Healthcare Provider Details

I. General information

NPI: 1659637544
Provider Name (Legal Business Name): ALY M MOHAMED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2012
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1662 DOMINICAN WAY
SANTA CRUZ CA
95065-1522
US

IV. Provider business mailing address

16185 LOS GATOS BLVD STE 205
LOS GATOS CA
95032-4569
US

V. Phone/Fax

Practice location:
  • Phone: 831-460-7350
  • Fax:
Mailing address:
  • Phone: 541-908-2316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA154654
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125061304
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD2015-0700
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: