Basic Information
| Provider Information | |||||||||
| NPI: | 1750316139 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALAM | ||||||||
| FirstName: | MOHAMMED | ||||||||
| MiddleName: | FEROZ | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 299 W FOOTHILL BLVD | ||||||||
| Address2: | STE 212 | ||||||||
| City: | UPLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917863804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099498866 | ||||||||
| FaxNumber: | 9093850379 | ||||||||
| Practice Location | |||||||||
| Address1: | 536 E FOOTHILL BLVD | ||||||||
| Address2: | STE B | ||||||||
| City: | UPLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917863955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099815882 | ||||||||
| FaxNumber: | 9099460833 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 11/20/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | A33746 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 00A337460 | 05 | CA | MEDICAID |