Healthcare Provider Details

I. General information

NPI: 1215404058
Provider Name (Legal Business Name): MOHAMMED DIAB SALMAN SALMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2018
Last Update Date: 10/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8990 GARFIELD ST STE 12
RIVERSIDE CA
92503-3922
US

IV. Provider business mailing address

8990 GARFIELD ST STE 13
RIVERSIDE CA
92503-3922
US

V. Phone/Fax

Practice location:
  • Phone: 951-688-5232
  • Fax:
Mailing address:
  • Phone: 951-688-5232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH64772
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: