Healthcare Provider Details

I. General information

NPI: 1245712025
Provider Name (Legal Business Name): SINAN NABIL SHAWKAT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2018
Last Update Date: 09/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2516 JAMACHA ROAD
EL CAJON CA
92019
US

IV. Provider business mailing address

2516 JAMACHA ROAD
EL CAJON CA
92019
US

V. Phone/Fax

Practice location:
  • Phone: 619-670-9769
  • Fax:
Mailing address:
  • Phone: 619-670-9769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number78287
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: