Healthcare Provider Details

I. General information

NPI: 1770928087
Provider Name (Legal Business Name): QAZI MOHSIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2013
Last Update Date: 05/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 TACOMA AVE
SUNNYSIDE WA
98944-2263
US

IV. Provider business mailing address

3921 SILVER LACE LN
REDDING CA
96001-6303
US

V. Phone/Fax

Practice location:
  • Phone: 702-453-3799
  • Fax:
Mailing address:
  • Phone: 702-453-3799
  • Fax: 702-453-5741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD60077994
License Number StateWA

VIII. Authorized Official

Name: LORI LABRECQUE
Title or Position: ACCTS MGR
Credential:
Phone: 702-453-3799