Healthcare Provider Details

I. General information

NPI: 1396232328
Provider Name (Legal Business Name): DIYA K ALNAJJAR MB.CHB.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2018
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17803 LA CANTERA TER APT 17803
SAN ANTONIO TX
78256-2545
US

IV. Provider business mailing address

40124 HIGHWAY 27 STE 104
DAVENPORT FL
33837-5905
US

V. Phone/Fax

Practice location:
  • Phone: 210-862-6141
  • Fax:
Mailing address:
  • Phone: 863-421-7626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME160391
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: