1164657268 NPI number — MOHAMMAD ABUL FIELAT DDS INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164657268 NPI number — MOHAMMAD ABUL FIELAT DDS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOHAMMAD ABUL FIELAT DDS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164657268
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/06/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1358 W 6TH STREET STE #102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORONA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92882
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-739-7970
Provider Business Mailing Address Fax Number:
951-793-7723

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1195 MAGNOLIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORONA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92879
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-339-3005
Provider Business Practice Location Address Fax Number:
951-793-7723
Provider Enumeration Date:
05/19/2009

Additional Information

Authorized Official

Authorized Official Last Name:
ABUL-FIELAT
Authorized Official First Name:
MOHAMAD
Authorized Official Middle Name:
G
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
951-688-5437

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  D43302 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223P0221X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1063532802 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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