MEDICARE: LAYTH AL SAUD CNIM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZE0600X	Electroneurodiagnostic Specialist/Technologist
2	246ZE0600X	Electroneurodiagnostic Specialist/Technologist	3998

General Provider Information

NPI Number	:	1740869932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAYTH AL SAUD CNIM

Provider Business Mailing Address
First Line	:	12362 SYLVAN ST
Second Line	:
City	:	N HOLLYWOOD
State	:	CA
Zip	:	91606-3109
Country	:	US
Telephone Number	:	949-426-5347
Fax Number	:

Provider Business Practice Location Address
First Line	:	2907 SHELTER ISLAND DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92106-2743
Country	:	US
Telephone Number	:	602-734-1405
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2021
Last Update Date	:	04/05/2021

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Directions to “ LAYTH AL SAUD CNIM” Practice Location

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