Provider Demographics
NPI:1114476306
Name:MOHAMMED, TEMITOPE
Entity Type:Individual
Prefix:
First Name:TEMITOPE
Middle Name:
Last Name:MOHAMMED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8850 FAIR OAKS XING
Mailing Address - Street 2:1059
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-7976
Mailing Address - Country:US
Mailing Address - Phone:347-898-4661
Mailing Address - Fax:
Practice Address - Street 1:8850 FAIR OAKS XING
Practice Address - Street 2:1059
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-7976
Practice Address - Country:US
Practice Address - Phone:347-898-4661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY81-2137066343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)