Provider Demographics
NPI:1386199818
Name:MOHAMMAD, AZIZA
Entity Type:Individual
Prefix:
First Name:AZIZA
Middle Name:
Last Name:MOHAMMAD
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 1:1820 PRESTON PARK BLVD
Mailing Address - Street 2:SUITE 1450
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-3656
Mailing Address - Country:US
Mailing Address - Phone:972-964-0363
Mailing Address - Fax:972-612-5604
Practice Address - Street 1:1820 PRESTON PARK BLVD
Practice Address - Street 2:SUITE 1450
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-3656
Practice Address - Country:US
Practice Address - Phone:972-964-0363
Practice Address - Fax:972-612-5604
Is Sole Proprietor?:No
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131511363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily