Healthcare Provider Details

I. General information

NPI: 1215279682
Provider Name (Legal Business Name): MOHAMMED SUHAIL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2013
Last Update Date: 06/24/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31700 TEMECULA PKWY
TEMECULA CA
92592-5896
US

IV. Provider business mailing address

8605 SANTA MONICA BLVD PMB 25192
WEST HOLLYWOOD CA
90069-4109
US

V. Phone/Fax

Practice location:
  • Phone: 800-880-2973
  • Fax: 951-600-4493
Mailing address:
  • Phone: 800-880-2973
  • Fax: 951-600-4493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA133493
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: