1154507101 NPI number — MS. DEBORAH D MUHAMMAD LMT

Table of content: MS. DEBORAH D MUHAMMAD LMT (NPI 1154507101)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154507101 NPI number — MS. DEBORAH D MUHAMMAD LMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUHAMMAD
Provider First Name:
DEBORAH
Provider Middle Name:
D
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GOSSAGE
Provider Other First Name:
DEBORAH
Provider Other Middle Name:
D
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1154507101
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10355 HONEYTREE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOUNTAIN
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80817-4236
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-224-1851
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10355 HONEYTREE CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOUNTAIN
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80817-4236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-224-1851
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/20/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  130678 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1154507101 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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