Healthcare Provider Details

I. General information

NPI: 1164510285
Provider Name (Legal Business Name): SAAD MATTI BAKHAYA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 01/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 WEST AVENUE J SUITE 116
LANCASTER CA
93534
US

IV. Provider business mailing address

1629 WEST AVENUE J SUITE 116
LANCASTER CA
93534
US

V. Phone/Fax

Practice location:
  • Phone: 661-945-1511
  • Fax: 661-945-5539
Mailing address:
  • Phone: 661-945-1511
  • Fax: 661-945-5539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberA53067
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: