Provider Demographics
NPI:1750133799
Name:MEHIN-KAROUBI, MOJDEH
Entity type:Individual
Prefix:
First Name:MOJDEH
Middle Name:
Last Name:MEHIN-KAROUBI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15445 N 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-3622
Mailing Address - Country:US
Mailing Address - Phone:602-390-0160
Mailing Address - Fax:
Practice Address - Street 1:9401 W THUNDERBIRD RD STE 155
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4238
Practice Address - Country:US
Practice Address - Phone:602-390-0160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ303742363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily