Provider Demographics
NPI:1548079437
Name:MOHAMMAD, ANOUD
Entity type:Individual
Prefix:
First Name:ANOUD
Middle Name:
Last Name:MOHAMMAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7940 CHERRY AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-4021
Mailing Address - Country:US
Mailing Address - Phone:909-689-7588
Mailing Address - Fax:
Practice Address - Street 1:1436 N AYALA DR STE N
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-3109
Practice Address - Country:US
Practice Address - Phone:909-689-7588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered