Provider Demographics
NPI:1841243755
Name:DIAB, MOHAMMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:
Last Name:DIAB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 PARNASSUS AVE., MU320W
Mailing Address - Street 2:BOX 0728
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0728
Mailing Address - Country:US
Mailing Address - Phone:415-514-1519
Mailing Address - Fax:415-476-1304
Practice Address - Street 1:400 PARNASSUS AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0728
Practice Address - Country:US
Practice Address - Phone:415-353-9384
Practice Address - Fax:415-353-2299
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG86439207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G864390Medicaid
CAG80946Medicare UPIN
CA00G864390Medicare PIN