Provider Demographics
NPI:1568439941
Name:BACHA, MOUNA (MD)
Entity Type:Individual
Prefix:DR
First Name:MOUNA
Middle Name:
Last Name:BACHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8137 COTTONWOOD CT
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33776-3448
Mailing Address - Country:US
Mailing Address - Phone:727-298-8496
Mailing Address - Fax:727-445-7566
Practice Address - Street 1:1173 TURNER ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-4135
Practice Address - Country:US
Practice Address - Phone:727-298-8496
Practice Address - Fax:727-445-7566
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81788207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262959300Medicaid
FL262959300Medicaid
FLH41449Medicare UPIN