MEDICARE: MOHAMAD MOUTAZ ALMAWALDI MD

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	207RN0300X	Nephrology Physician	35-03-2783	OH
2	207RN0300X	Nephrology Physician	A49796	CA

General Provider Information

NPI Number	:	1750390027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAMAD MOUTAZ ALMAWALDI MD

Provider Business Mailing Address
First Line	:	5120 HILL RD EAST
Second Line	:	PO BOX 1917
City	:	LAKEPORT
State	:	CA
Zip	:	95453-6300
Country	:	US
Telephone Number	:	707-263-4766
Fax Number	:	707-263-4771

Provider Business Practice Location Address
First Line	:	5120 HILL RD E
Second Line	:
City	:	LAKEPORT
State	:	CA
Zip	:	95453-6300
Country	:	US
Telephone Number	:	707-263-4766
Fax Number	:	707-263-4771

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	06/30/2017

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