Healthcare Provider Details

I. General information

NPI: 1710755988
Provider Name (Legal Business Name): SAAD MUNJED SAEED ALQESMEKHAEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 12/18/2023
Certification Date: 12/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10003 CANYONSIDE CT
SPRING VALLEY CA
91977-6917
US

IV. Provider business mailing address

10003 CANYONSIDE CT
SPRING VALLEY CA
91977-6917
US

V. Phone/Fax

Practice location:
  • Phone: 619-402-2096
  • Fax:
Mailing address:
  • Phone: 619-402-2096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number88711
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: