Provider Demographics
NPI:1881256600
Name:AJMAL, MUHAMMED
Entity type:Individual
Prefix:
First Name:MUHAMMED
Middle Name:
Last Name:AJMAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DBA LAKEWOOD 24 HR
Other - Middle Name:PERSONAL
Other - Last Name:CARE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DBA
Mailing Address - Street 1:8416 MESA DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77028-2003
Mailing Address - Country:US
Mailing Address - Phone:713-633-3609
Mailing Address - Fax:713-631-8476
Practice Address - Street 1:8416 MESA DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77028-2003
Practice Address - Country:US
Practice Address - Phone:713-633-3609
Practice Address - Fax:713-631-8476
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-02
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX148780310400000X
310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility