Provider Demographics
NPI:1275742074
Name:MOBARAK, RAHA M (DPM)
Entity Type:Individual
Prefix:DR
First Name:RAHA
Middle Name:M
Last Name:MOBARAK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 DORAL CT
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8616
Mailing Address - Country:US
Mailing Address - Phone:575-521-0055
Mailing Address - Fax:575-521-0077
Practice Address - Street 1:2800 DORAL CT
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8616
Practice Address - Country:US
Practice Address - Phone:575-521-0055
Practice Address - Fax:575-521-0077
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM311213ES0103X
TX1933213ES0103X
NM402213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery