Provider Demographics
NPI:1841577376
Name:MOHAMMED AL-JASIM MD A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:MOHAMMED AL-JASIM MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-JASIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-336-3773
Mailing Address - Street 1:1600 S IMPERIAL AVE
Mailing Address - Street 2:8
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-4242
Mailing Address - Country:US
Mailing Address - Phone:760-336-3773
Mailing Address - Fax:760-370-3229
Practice Address - Street 1:1600 S IMPERIAL AVE
Practice Address - Street 2:8
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-4242
Practice Address - Country:US
Practice Address - Phone:760-336-3773
Practice Address - Fax:760-370-3229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-11
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82827207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty