Provider Demographics
NPI:1194372664
Name:MOHAMMED, DUSTIN RAKIM
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:RAKIM
Last Name:MOHAMMED
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 1:44300 LOWTREE AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-4171
Mailing Address - Country:US
Mailing Address - Phone:310-623-2796
Mailing Address - Fax:
Practice Address - Street 1:44300 LOWTREE AVE STE 102
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4171
Practice Address - Country:US
Practice Address - Phone:310-623-2796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator