Healthcare Provider Details

I. General information

NPI: 1790289619
Provider Name (Legal Business Name): LUAY HUSSEIN MASHAALLAH ALALAWI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 N 13TH AVE STE 2
UPLAND CA
91786-4963
US

IV. Provider business mailing address

685 N 13TH AVE STE 2
UPLAND CA
91786-4963
US

V. Phone/Fax

Practice location:
  • Phone: 909-500-8683
  • Fax: 909-931-1294
Mailing address:
  • Phone: 909-500-8683
  • Fax: 909-931-1294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberU1463
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberA174962
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: