Provider Demographics
NPI:1093572158
Name:WARRIORS CLINIC LLC
Entity Type:Organization
Organization Name:WARRIORS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-244-1358
Mailing Address - Street 1:3750 S RIVER PKWY APT 325
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4746
Mailing Address - Country:US
Mailing Address - Phone:602-244-1358
Mailing Address - Fax:
Practice Address - Street 1:3750 S RIVER PKWY APT 325
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4746
Practice Address - Country:US
Practice Address - Phone:602-244-1358
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health