Basic Information
| Provider Information | |||||||||
| NPI: | 1265444723 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AL-HAFEZ | ||||||||
| FirstName: | MOHAMAD ALTAYEB | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 560 HAIGHT ST. | ||||||||
| Address2: | UNIT 101 | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4158456040 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1221 HIGHLAND AVE | ||||||||
| Address2: | |||||||||
| City: | CLARKSTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 994032829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607545858 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2006 | ||||||||
| LastUpdateDate: | 12/04/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QH0002X | MD158168 | OR | N | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine | 207R00000X | MD158168 | OR | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD00040497 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.