MEDICARE: MOWAFAG MOHAMED

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	106E00000X	Assistant Behavior Analyst

General Provider Information

NPI Number	:	1073200903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOWAFAG MOHAMED

Provider Business Mailing Address
First Line	:	8416 XERXES AVE N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55444-1469
Country	:	US
Telephone Number	:	651-493-5102
Fax Number	:	651-666-1236

Provider Business Practice Location Address
First Line	:	8416 XERXES AVE N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55444-1469
Country	:	US
Telephone Number	:	651-493-5102
Fax Number	:	651-666-1236

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

Provider Enumeration Date	:	04/20/2023
Last Update Date	:	04/20/2023

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Directions to “ MOWAFAG MOHAMED ” Practice Location

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