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NPI Code Detail

MEDICARE: PROF. GEORGIA MONIQUE MOKHA PHD ATC

MEDICARE: PROF. GEORGIA MONIQUE MOKHA PHD ATC
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
12255A2300XAthletic TrainerAL 895FL

General Provider Information

NPI Number : 1912970898
Entity Type Code : Individual
Provider Name (Legal Business Name) : PROF. GEORGIA MONIQUE MOKHA PHD ATC
Provider Business Mailing Address
First Line : 95 S SHORE DR
Second Line : #2
City : MIAMI BEACH
State : FL
Zip : 33141-3946
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11300 NE 2ND AVE
Second Line :
City : MIAMI SHORES
State : FL
Zip : 33161-6628
Country : US
Telephone Number : 305-899-3555
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2006
Last Update Date : 07/08/2007

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