Healthcare Provider Details

I. General information

NPI: 1871032888
Provider Name (Legal Business Name): AYMAN HADI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2017
Last Update Date: 02/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5712 BALTIMORE DR UNIT 453
LA MESA CA
91942-1695
US

IV. Provider business mailing address

5712 BALTIMORE DR UNIT 453
LA MESA CA
91942-1695
US

V. Phone/Fax

Practice location:
  • Phone: 619-387-6263
  • Fax:
Mailing address:
  • Phone: 619-387-6263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License NumberRPH68532
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: