Provider Demographics
NPI:1912994989
Name:SULIMAN, MAHOMED ESSOP (MD)
Entity Type:Individual
Prefix:MR
First Name:MAHOMED
Middle Name:ESSOP
Last Name:SULIMAN
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:PO BOX 2616
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92244-2616
Mailing Address - Country:US
Mailing Address - Phone:760-337-1000
Mailing Address - Fax:760-353-7017
Practice Address - Street 1:1594 S IMPERIAL AVE
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-4241
Practice Address - Country:US
Practice Address - Phone:760-337-1000
Practice Address - Fax:760-353-7017
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC42511207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C42511Medicaid
CA00C42511Medicaid
CAC42511Medicare PIN