Healthcare Provider Details

I. General information

NPI: 1275635492
Provider Name (Legal Business Name): LAMA AL-KHOURY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3390 UNIVERSITY AVE STE 100
RIVERSIDE CA
92501-3315
US

IV. Provider business mailing address

3390 UNIVERSITY AVE STE 100
RIVERSIDE CA
92501-3315
US

V. Phone/Fax

Practice location:
  • Phone: 844-827-8000
  • Fax: 951-530-4782
Mailing address:
  • Phone: 844-827-8000
  • Fax: 951-530-4782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA76252
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: