Healthcare Provider Details

I. General information

NPI: 1932141520
Provider Name (Legal Business Name): ALAA ELHAJ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 03/18/2020
Certification Date: 03/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 DWIGHT WAY STE 4190
BERKELEY CA
94704-2608
US

IV. Provider business mailing address

2001 DWIGHT WAY STE 4190
BERKELEY CA
94704-2608
US

V. Phone/Fax

Practice location:
  • Phone: 510-204-4635
  • Fax: 510-204-3060
Mailing address:
  • Phone: 510-204-4635
  • Fax: 510-204-3060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC144314
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: