Provider Demographics
NPI:1518378074
Name:MOHAMED, SARA
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:MOHAMED
Suffix:
Gender:F
Credentials:
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Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4840 E INDIAN SCHOOL RD
Mailing Address - Street 2:STE 102
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-5500
Mailing Address - Country:US
Mailing Address - Phone:602-954-3919
Mailing Address - Fax:602-954-3670
Practice Address - Street 1:9305 W THOMAS RD.
Practice Address - Street 2:STE 350
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3372
Practice Address - Country:US
Practice Address - Phone:623-478-8000
Practice Address - Fax:623-478-8003
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-17
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZAP5582363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ915090Medicaid
AZ915090Medicaid