Provider Demographics
NPI:1205380060
Name:MOHAMMED, SAQUIB (FNP)
Entity type:Individual
Prefix:
First Name:SAQUIB
Middle Name:
Last Name:MOHAMMED
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8875 SOOTHING CT
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-5985
Mailing Address - Country:US
Mailing Address - Phone:818-938-6183
Mailing Address - Fax:818-338-0482
Practice Address - Street 1:2680 E RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-7307
Practice Address - Country:US
Practice Address - Phone:909-469-9013
Practice Address - Fax:909-469-9014
Is Sole Proprietor?:No
Enumeration Date:2016-08-10
Last Update Date:2025-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95034566363L00000X
NMCNP53016363LF0000X
CARPH82668183500000X
NMRP00008566183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No183500000XPharmacy Service ProvidersPharmacist