Provider Demographics
NPI:1043696248
Name:MOHAMAD, YOUSUF
Entity type:Individual
Prefix:MR
First Name:YOUSUF
Middle Name:
Last Name:MOHAMAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2319 SOUTHLAKE CT
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038
Mailing Address - Country:US
Mailing Address - Phone:817-723-1439
Mailing Address - Fax:
Practice Address - Street 1:2319 SOUTHLAKE CT
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-5641
Practice Address - Country:US
Practice Address - Phone:817-723-1439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00570502343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)