Healthcare Provider Details

I. General information

NPI: 1932843604
Provider Name (Legal Business Name): LANA SAMEER HADDAD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2022
Last Update Date: 08/09/2022
Certification Date: 08/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14350 MERIDIAN PKWY
RIVERSIDE CA
92518-3035
US

IV. Provider business mailing address

3318 GARDEN DR
SAN BERNARDINO CA
92404-2644
US

V. Phone/Fax

Practice location:
  • Phone: 855-982-7284
  • Fax:
Mailing address:
  • Phone: 909-910-6357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: