Individual
MS. CORETTA MUHAMMAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9371 W WILLIAMS ST, TOLLESON, AZ 85353-8342
(623) 848-6252
Mailing address
9371 W WILLIAMS ST, TOLLESON, AZ 85353-8342
(623) 848-6252
Taxonomy
Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
1419
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
816332
AHCCCS ID NUMBER
AZ
Enumeration date
11/21/2006
Last updated
04/08/2010
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