Healthcare Provider Details

I. General information

NPI: 1487233938
Provider Name (Legal Business Name): ALANA RETA GHANIM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 W MAIN ST STE 100
EL CAJON CA
92020-3325
US

IV. Provider business mailing address

1931 VEREDA CT
EL CAJON CA
92019-3803
US

V. Phone/Fax

Practice location:
  • Phone: 619-401-0404
  • Fax:
Mailing address:
  • Phone: 619-729-1411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA192893
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: