Healthcare Provider Details

I. General information

NPI: 1659666972
Provider Name (Legal Business Name): NADER S. ABUHALAWA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 06/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21738 US HIGHWAY 18
APPLE VALLEY CA
92307-3916
US

IV. Provider business mailing address

21738 US HIGHWAY 18
APPLE VALLEY CA
92307
US

V. Phone/Fax

Practice location:
  • Phone: 760-927-2899
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number65156
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: