Healthcare Provider Details

I. General information

NPI: 1750935987
Provider Name (Legal Business Name): MUHAMMAD L. ROBBALAA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2019
Last Update Date: 07/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 W 3RD ST # A
CHESTER PA
19013-3622
US

IV. Provider business mailing address

1120 W 3RD ST # A
CHESTER PA
19013-3622
US

V. Phone/Fax

Practice location:
  • Phone: 215-435-4203
  • Fax:
Mailing address:
  • Phone: 215-435-4203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: