Provider Demographics
NPI:1407420714
Name:TARAWALLIE, MOHAMED LAMIN
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:LAMIN
Last Name:TARAWALLIE
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 1:590 E 222ND ST
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-2024
Mailing Address - Country:US
Mailing Address - Phone:216-269-9304
Mailing Address - Fax:216-554-3214
Practice Address - Street 1:590 E 222ND ST
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123-2024
Practice Address - Country:US
Practice Address - Phone:216-269-9304
Practice Address - Fax:216-554-3214
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-20
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst