Provider Demographics
NPI:1053183475
Name:ALI, MOHAMED NOOR
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:NOOR
Last Name:ALI
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 1:15710 SE STARK ST APT 14
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-3551
Mailing Address - Country:US
Mailing Address - Phone:971-331-9024
Mailing Address - Fax:971-200-5766
Practice Address - Street 1:12415 NE GLISAN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-2144
Practice Address - Country:US
Practice Address - Phone:971-244-5838
Practice Address - Fax:971-200-5766
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care