Provider Demographics
NPI:1215359468
Name:MAHMOUD, SALLY (RN, BSN, PUBLIC HEAL)
Entity Type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:
Last Name:MAHMOUD
Suffix:
Gender:F
Credentials:RN, BSN, PUBLIC HEAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4065 COUNTY CIRCLE DRIVE
Mailing Address - Street 2:COUNTY OF RIVERSIDE DEPARTMENT OF PUBLIC HEALTH PHN/MCA
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503
Mailing Address - Country:US
Mailing Address - Phone:951-358-5438
Mailing Address - Fax:951-358-5019
Practice Address - Street 1:4065 COUNTY CIRCLE DRIVE
Practice Address - Street 2:COUNTY OF RIVERSIDE DEPARTMENT OF PUBLIC HEALTH PHN/MCA
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503
Practice Address - Country:US
Practice Address - Phone:951-358-5438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA542956RN163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health