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General NPI Number Information
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NPI Number | 1518672278
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Entity Type | Organization
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Legal Business Name | KHAKWANI AND MOHAMMAD MEDICAL PC
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Dates
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Enumeration Date | 01/17/2023
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 3540 E BASELINE RD STE 130
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City | PHOENIX
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State | AZ
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Zip | 85042-9629
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Country | US
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Telephone | 623-257-7559
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 660047
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City | DALLAS
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State | TX
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Zip | 75266-2900
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Country | US
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Telephone | 702-820-5713
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | VALERIE DENISE ESTRADA
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Credential |
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Telephone | 469-718-2768
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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