MEDICARE: DUSTIN RAKIM MOHAMMED

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1194372664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DUSTIN RAKIM MOHAMMED

Provider Business Mailing Address
First Line	:	44300 LOWTREE AVE STE 102
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93534-4171
Country	:	US
Telephone Number	:	310-623-2796
Fax Number	:

Provider Business Practice Location Address
First Line	:	44300 LOWTREE AVE STE 102
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93534-4171
Country	:	US
Telephone Number	:	310-623-2796
Fax Number	:

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

Provider Enumeration Date	:	08/20/2019
Last Update Date	:	08/20/2019

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