Provider Demographics
NPI:1629227822
Name:TAHIRY, MOHAMMAD AKRAM
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:AKRAM
Last Name:TAHIRY
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 1:593 VIA DEL CABALLO
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-8911
Mailing Address - Country:US
Mailing Address - Phone:760-672-0757
Mailing Address - Fax:760-744-5723
Practice Address - Street 1:593 VIA DEL CABALLO
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-8911
Practice Address - Country:US
Practice Address - Phone:760-672-0757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASOSL200813810167172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver