MEDICARE: ABDELNASIR 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	172A00000X	Driver

General Provider Information

NPI Number	:	1255763132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABDELNASIR MOHAMED

Provider Business Mailing Address
First Line	:	6131 N 27TH AVE APT 2085
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85017-1759
Country	:	US
Telephone Number	:	602-561-2095
Fax Number	:	602-916-1416

Provider Business Practice Location Address
First Line	:	6131 N 27TH AVE APT 2085
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85017-1759
Country	:	US
Telephone Number	:	602-561-2095
Fax Number	:	602-916-1416

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

Provider Enumeration Date	:	08/02/2013
Last Update Date	:	08/02/2013

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Directions to “ ABDELNASIR MOHAMED ” Practice Location

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