Basic Information
| Provider Information | |||||||||
| NPI: | 1346590528 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ELHANAFY | ||||||||
| FirstName: | MOHAMED | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | RRT-RCP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 31075 QUARRY ST | ||||||||
| Address2: | |||||||||
| City: | MENTONE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923591516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098257084 | ||||||||
| FaxNumber: | 9097773214 | ||||||||
| Practice Location | |||||||||
| Address1: | 31075 QUARRY ST | ||||||||
| Address2: | |||||||||
| City: | MENTONE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923591516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098257084 | ||||||||
| FaxNumber: | 9097773214 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2012 | ||||||||
| LastUpdateDate: | 09/14/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 227900000X | 20294 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Registered |
No ID Information.