Healthcare Provider Details

I. General information

NPI: 1407423668
Provider Name (Legal Business Name): ALA' ALQUDAH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date: 04/03/2023
Reactivation Date: 04/20/2023

III. Provider practice location address

305 E CENTER AVE
VISALIA CA
93291-6331
US

IV. Provider business mailing address

305 E CENTER AVE
VISALIA CA
93291-6331
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-1892
  • Fax:
Mailing address:
  • Phone: 313-745-1892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA196284
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: