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MOHAMED COULIBALY DIT FALL

Family >> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1255745840

Individual Registrant:
 MOHAMED  COULIBALY DIT FALL 
Gender: M
Sole Proprietor

Location and contact information for practice:
4781 W SANTA MARIA DR  AMADO, AZ 85645-9744 US
Tel: 520-256-7028  Fax: --

Contact information for business:
4781 W SANTA MARIA DR  AMADO, AZ 85645-9744 US
Tel: 520-256-7028  Fax: --

Registration Information:
NPI: 1255745840
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363LF0000XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
Family
AZTAP5641

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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