Provider Demographics
NPI:1750390027
Name:ALMAWALDI, MOHAMAD MOUTAZ (MD)
Entity type:Individual
Prefix:
First Name:MOHAMAD MOUTAZ
Middle Name:
Last Name:ALMAWALDI
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 1:5120 HILL RD EAST
Mailing Address - Street 2:PO BOX 1917
Mailing Address - City:LAKEPORT
Mailing Address - State:CA
Mailing Address - Zip Code:95453-6300
Mailing Address - Country:US
Mailing Address - Phone:707-263-4766
Mailing Address - Fax:707-263-4771
Practice Address - Street 1:5120 HILL RD E
Practice Address - Street 2:
Practice Address - City:LAKEPORT
Practice Address - State:CA
Practice Address - Zip Code:95453-6300
Practice Address - Country:US
Practice Address - Phone:707-263-4766
Practice Address - Fax:707-263-4771
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-03-2783207RN0300X
CAA49796207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA 49796Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
OHPA0350522Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER