Healthcare Provider Details

I. General information

NPI: 1851746630
Provider Name (Legal Business Name): WALLA ALFARAJ M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2016
Last Update Date: 03/14/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 BAILEY AVE
NEEDLES CA
92363-3103
US

IV. Provider business mailing address

1409 N ALTA VISTA BLVD APT 309
LOS ANGELES CA
90046-8219
US

V. Phone/Fax

Practice location:
  • Phone: 760-326-7100
  • Fax:
Mailing address:
  • Phone: 713-314-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA162172
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: