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NPI Code Detail

MEDICARE: IDHIL MOHAMED

MEDICARE: IDHIL 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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1194688986
Entity Type Code : Individual
Provider Name (Legal Business Name) : IDHIL MOHAMED
Provider Business Mailing Address
First Line : 100 N PACIFIC COAST HWY STE 1400
Second Line :
City : EL SEGUNDO
State : CA
Zip : 90245-5602
Country : US
Telephone Number : 310-856-0800
Fax Number : 855-568-2494
Provider Business Practice Location Address
First Line : 3111 124TH AVE NW STE 150
Second Line :
City : COON RAPIDS
State : MN
Zip : 55433-4581
Country : US
Telephone Number : 763-272-5877
Fax Number : 855-568-2494
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2025
Last Update Date : 12/08/2025

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Directions to “ IDHIL MOHAMED ” Practice Location

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