Healthcare Provider Details

I. General information

NPI: 1346905502
Provider Name (Legal Business Name): KHULOUD KHALID ALMUGBEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2021
Last Update Date: 11/03/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CENTRE ST
ROSLINDALE MA
02131-1000
US

IV. Provider business mailing address

635 ALBANY STREET G-158
BOSTON MA
02118
US

V. Phone/Fax

Practice location:
  • Phone: 617-363-8000
  • Fax:
Mailing address:
  • Phone: 617-358-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: