Healthcare Provider Details

I. General information

NPI: 1184084865
Provider Name (Legal Business Name): MOHAMMAD YOUSEF ALKHATIB MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2016
Last Update Date: 02/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79405 HIGHWAY 111 STE 9-334
LA QUINTA CA
92253-8300
US

IV. Provider business mailing address

47750 ADAMS ST APT 1223
LA QUINTA CA
92253-7107
US

V. Phone/Fax

Practice location:
  • Phone: 760-863-1592
  • Fax: 866-544-2050
Mailing address:
  • Phone: 760-863-1592
  • Fax: 866-544-2050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberA117007
License Number StateCA

VIII. Authorized Official

Name: MR. MOHAMMAD Y ALKHATIB
Title or Position: PRESIDENT/PHYSICIAN
Credential: M.D.
Phone: 760-619-7656