Healthcare Provider Details

I. General information

NPI: 1396238184
Provider Name (Legal Business Name): DELAIR LUCAS ALNAJJAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2018
Last Update Date: 02/13/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41540 WINCHESTER RD
TEMECULA CA
92590-4877
US

IV. Provider business mailing address

PO BOX 743
BONSALL CA
92003-0743
US

V. Phone/Fax

Practice location:
  • Phone: 951-365-5585
  • Fax: 951-404-7074
Mailing address:
  • Phone: 248-840-5871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301115471
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA181114
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301505557
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: