Healthcare Provider Details

I. General information

NPI: 1639170806
Provider Name (Legal Business Name): ABDULLAH M AL DWAIRI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 COHASSET RD
CHICO CA
95926-2213
US

IV. Provider business mailing address

PO BOX A D
YUBA CITY CA
95992-1396
US

V. Phone/Fax

Practice location:
  • Phone: 530-342-4395
  • Fax: 530-894-2325
Mailing address:
  • Phone: 530-751-3769
  • Fax: 530-751-1237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA79949
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberA79949
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: