Individual
MR. OMER MOHAMED
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1606 W PEORIA AVE APT 103, PHOENIX, AZ 85029-5702
(520) 251-7391
Mailing address
PO BOX 7501, PHOENIX, AZ 85011-7501
(520) 251-7391
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
D04629645
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D04629645
MERCY CARE PLAN
AZ
Enumeration date
12/09/2019
Last updated
12/09/2019
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