Healthcare Provider Details

I. General information

NPI: 1578798013
Provider Name (Legal Business Name): AHMED ADEL SALEM D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2009
Last Update Date: 10/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 GROSSMONT CENTER DR
LA MESA CA
91942-3019
US

IV. Provider business mailing address

PO BOX 3363
LA JOLLA CA
92038-3363
US

V. Phone/Fax

Practice location:
  • Phone: 888-664-8297
  • Fax: 866-313-8916
Mailing address:
  • Phone: 858-336-8177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A11670
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberUO2112
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number20A11670
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number20A11670
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: