Provider Demographics
NPI:1376931642
Name:MOHAMMED, FATUMA
Entity Type:Individual
Prefix:
First Name:FATUMA
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 1:3714 S HIGHLAND DR APT 29
Mailing Address - Street 2:
Mailing Address - City:S SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84106-3264
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3714 S HIGHLAND DR APT 29
Practice Address - Street 2:
Practice Address - City:S SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84106-3264
Practice Address - Country:US
Practice Address - Phone:385-229-7864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter