Individual
MOHAMMED BOUSOFA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1500 CITYWEST BLVD, STE. 300, HOUSTON, TX 77042-2300
(713) 620-4000
(713) 458-4229
Mailing address
PO BOX 840853, DALLAS, TX 75284-0865
(972) 715-5000
(972) 715-9976
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
187091
TN
367500000X
Certified Registered Nurse Anesthetist
Primary
AP127291
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
345516401
—
TX
01
—
8157UK
BCBS
TX
01
—
RR MEDICARE
P01540692
TX
Enumeration date
02/03/2015
Last updated
07/14/2020
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