MEDICARE: MOHAMED NOUR

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	310400000X	Assisted Living Facility	AL12794H	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	205088	OTHER	AZ	DES ARIZONA AHCCCS

General Provider Information

NPI Number	:	1942072426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAMED NOUR

Provider Business Mailing Address
First Line	:	4734 E EDISON ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-2721
Country	:	US
Telephone Number	:	520-312-9436
Fax Number	:

Provider Business Practice Location Address
First Line	:	4734 E EDISON ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-2721
Country	:	US
Telephone Number	:	520-312-9436
Fax Number	:

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

Provider Enumeration Date	:	10/26/2023
Last Update Date	:	03/17/2025

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Directions to “ MOHAMED NOUR ” Practice Location

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