Healthcare Provider Details

I. General information

NPI: 1265696975
Provider Name (Legal Business Name): HUMAM ALOSH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2008
Last Update Date: 09/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E LAKEVIEW AVE
WOODLAKE CA
93286-1301
US

IV. Provider business mailing address

201 E LAKEVIEW AVE
WOODLAKE CA
93286-1301
US

V. Phone/Fax

Practice location:
  • Phone: 877-960-3426
  • Fax:
Mailing address:
  • Phone: 877-960-3426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA111581
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberA111581
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: