Provider Demographics
NPI:1801607056
Name:MOHAMED, TAWFIG HASSAN
Entity type:Individual
Prefix:
First Name:TAWFIG
Middle Name:HASSAN
Last Name:MOHAMED
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 1:2705 E EMELITA AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-4630
Mailing Address - Country:US
Mailing Address - Phone:703-217-0021
Mailing Address - Fax:
Practice Address - Street 1:2705 E EMELITA AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-4630
Practice Address - Country:US
Practice Address - Phone:703-217-0021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAA61431949347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle