Healthcare Provider Details

I. General information

NPI: 1144881624
Provider Name (Legal Business Name): BASHEER ABDULHASAN ALWAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2019
Last Update Date: 06/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 AVOCADO AVE
EL CAJON CA
92020-7702
US

IV. Provider business mailing address

11418 VIA RANCHO SAN DIEGO UNIT 67
EL CAJON CA
92019-5232
US

V. Phone/Fax

Practice location:
  • Phone: 619-447-2332
  • Fax:
Mailing address:
  • Phone: 619-201-7569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number80258
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: