Provider Demographics
NPI:1295079242
Name:ELBAZ, MOHAMED A (MS MB(ASCP))
Entity type:Individual
Prefix:MR
First Name:MOHAMED
Middle Name:A
Last Name:ELBAZ
Suffix:
Gender:M
Credentials:MS MB(ASCP)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5351 S VINCENT
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-9113
Mailing Address - Country:US
Mailing Address - Phone:503-464-6467
Mailing Address - Fax:
Practice Address - Street 1:1050 LAS TABLAS RD STE 14
Practice Address - Street 2:
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-9480
Practice Address - Country:US
Practice Address - Phone:503-464-6467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1825246QM0706X
246ZB0500X
TX246QL0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QL0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyLaboratory Management
No246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist
No246ZB0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherBiochemist