Provider Demographics
NPI:1891451076
Name:ESSOULAIMANI, MOHAMED SEMO
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:SEMO
Last Name:ESSOULAIMANI
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 1:1375 PASADENA AVE S LOT 612
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:FL
Mailing Address - Zip Code:33707-3724
Mailing Address - Country:US
Mailing Address - Phone:727-385-8535
Mailing Address - Fax:
Practice Address - Street 1:3100 75TH ST N BLDG 2
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-2326
Practice Address - Country:US
Practice Address - Phone:727-371-9975
Practice Address - Fax:727-491-5379
Is Sole Proprietor?:No
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician