Healthcare Provider Details

I. General information

NPI: 1528078979
Provider Name (Legal Business Name): SAAD K ALJOHER RCP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8978 BAINBRIDGE PL
STOCKTON CA
95209-4807
US

IV. Provider business mailing address

6 OLLIE CT
ELK GROVE CA
95758-7238
US

V. Phone/Fax

Practice location:
  • Phone: 209-470-6848
  • Fax:
Mailing address:
  • Phone: 916-288-0938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberRCP22828
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: