Healthcare Provider Details

I. General information

NPI: 1740826916
Provider Name (Legal Business Name): FAIZA MOHAMED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2019
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 WAYZATA BLVD
ST LOUIS PARK MN
55426-1623
US

IV. Provider business mailing address

7601 WAYZATA BLVD
MINNEAPOLIS MN
55426-1623
US

V. Phone/Fax

Practice location:
  • Phone: 507-319-2839
  • Fax:
Mailing address:
  • Phone: 507-319-2839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: