Individual
MOHAMED KOUBASSI JABATI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1229 HALE ST, PHILADELPHIA, PA 19111-5829
(215) 850-8057
Mailing address
1229 HALE ST, PHILADELPHIA, PA 19111-5829
(215) 850-8057
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
SW131325
PA
Other
Enumeration date
10/13/2015
Last updated
10/13/2015
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