Provider Demographics
NPI:1770771412
Name:HASHEM, MOHAMED KAMEL (RPT)
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:KAMEL
Last Name:HASHEM
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 S ALICE WAY
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-4032
Mailing Address - Country:US
Mailing Address - Phone:714-269-4645
Mailing Address - Fax:877-991-5678
Practice Address - Street 1:191 S ALICE WAY
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-4032
Practice Address - Country:US
Practice Address - Phone:714-269-4645
Practice Address - Fax:877-991-5678
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT19881225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT19881Medicare PIN