MEDICARE: MAZIN AL MOUSA

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1083420970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAZIN AL MOUSA

Provider Business Mailing Address
First Line	:	8660 CLEVELAND AVE NW
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-4800
Country	:	US
Telephone Number	:	330-780-1809
Fax Number	:

Provider Business Practice Location Address
First Line	:	8660 CLEVELAND AVE NW
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-4800
Country	:	US
Telephone Number	:	330-780-1809
Fax Number	:

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

Provider Enumeration Date	:	12/05/2024
Last Update Date	:	12/05/2024

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Directions to “ MAZIN AL MOUSA ” Practice Location

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