Provider Demographics
NPI:1033424668
Name:MOHAMED, SABIR O (OWNER)
Entity Type:Individual
Prefix:
First Name:SABIR
Middle Name:O
Last Name:MOHAMED
Suffix:
Gender:M
Credentials:OWNER
Other - Prefix:
Other - First Name:SABIR
Other - Middle Name:O
Other - Last Name:MOHAMED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OWNER
Mailing Address - Street 1:8528 N 43RD DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-5302
Mailing Address - Country:US
Mailing Address - Phone:602-722-8160
Mailing Address - Fax:
Practice Address - Street 1:8528 N 43RD DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-5302
Practice Address - Country:US
Practice Address - Phone:602-722-8160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-06
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ528653343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)