MEDICARE: TRIUMPH PSYCHIATRY LLC

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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1225785835
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRIUMPH PSYCHIATRY LLC

Provider Business Mailing Address
First Line	:	109 W FORTUNE ST APT 1516
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33602-3221
Country	:	US
Telephone Number	:	248-881-7971
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 W FORTUNE ST APT 1516
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33602-3221
Country	:	US
Telephone Number	:	248-881-7971
Fax Number	:

Authorized Official
Title or Position	:	AO
Name	:	DR. RODWAN MAHFOUZ
Credential	:	M.D.
Telephone Number	:	917-300-9610

Provider Enumeration Date	:	03/03/2022
Last Update Date	:	03/03/2022

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