MEDICARE: LAURA LYNN MUHAMMAD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1023432986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA LYNN MUHAMMAD

Provider Business Mailing Address
First Line	:	1234 CHURING DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78245-1527
Country	:	US
Telephone Number	:	210-609-8515
Fax Number	:	210-680-8701

Provider Business Practice Location Address
First Line	:	1234 CHURING DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78245-1527
Country	:	US
Telephone Number	:	210-609-8515
Fax Number	:	210-680-8701

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2014
Last Update Date	:	02/13/2014

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