Provider Demographics
NPI:1083984017
Name:MAHMOUD, MAHMOUD AHMED
Entity Type:Individual
Prefix:MR
First Name:MAHMOUD
Middle Name:AHMED
Last Name:MAHMOUD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4329 DALEHURST LN
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95377-8276
Mailing Address - Country:US
Mailing Address - Phone:209-839-8552
Mailing Address - Fax:
Practice Address - Street 1:4329 DALEHURST LN
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95377-8276
Practice Address - Country:US
Practice Address - Phone:209-839-8552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79934343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)