Healthcare Provider Details

I. General information

NPI: 1740701549
Provider Name (Legal Business Name): JOE SALIBA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2017
Last Update Date: 06/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W. ARBOR DR MC 8895
SAN DIEGO CA
92103
US

IV. Provider business mailing address

1455 KETTNER BLVD APT 1601
SAN DIEGO CA
92101-2495
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-1967
  • Fax:
Mailing address:
  • Phone: 514-886-3156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number150102
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: