Healthcare Provider Details

I. General information

NPI: 1699686394
Provider Name (Legal Business Name): MOHAMED HABOTT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4265 NW 1ST PL
DEERFIELD BCH FL
33442-9240
US

IV. Provider business mailing address

4265 NW 1ST PL
DEERFIELD BCH FL
33442-9240
US

V. Phone/Fax

Practice location:
  • Phone: 314-814-3955
  • Fax:
Mailing address:
  • Phone: 314-814-3955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberH130-541-70-449-0
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: