Provider Demographics
NPI:1306536446
Name:ALGBURI, MOHAMMED A
Entity type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:A
Last Name:ALGBURI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 OAKLEY CT
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95206-6357
Mailing Address - Country:US
Mailing Address - Phone:650-430-2132
Mailing Address - Fax:
Practice Address - Street 1:1860 OAKLEY CT
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95206-6357
Practice Address - Country:US
Practice Address - Phone:650-430-2132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAY2392471172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver