Provider Demographics
NPI:1013142801
Name:HUSSIEN-BAKR, MOHAMED MOKHTAR (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:MOKHTAR
Last Name:HUSSIEN-BAKR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MOHAMED
Other - Middle Name:MOKHTAR
Other - Last Name:HUSSIEN-BAKR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2260 E PALMDALE BLVD STE J
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-4952
Mailing Address - Country:US
Mailing Address - Phone:661-575-1800
Mailing Address - Fax:
Practice Address - Street 1:2260 E PALMDALE BLVD STE J
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-4952
Practice Address - Country:US
Practice Address - Phone:661-575-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1129212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry