Healthcare Provider Details

I. General information

NPI: 1578700332
Provider Name (Legal Business Name): HAITHAM JAMIL JUMA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2009
Last Update Date: 05/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11234 ANDERSON ST HOUSE OF STAFFING
LOMA LINDA CA
92354-2804
US

IV. Provider business mailing address

11234 ANDERSON STREET, CP 21005 HOUSE OF STAFFING
LOMA LINDA CA
92354-2804
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-8131
  • Fax: 909-555-8043
Mailing address:
  • Phone: 909-558-8131
  • Fax: 909-558-0430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License NumberA106369
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberA106369
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: