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General NPI Number Information
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NPI Number | 1376324103
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Entity Type | Individual
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Provider Name | ADHAM GHAZAL
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Gender | Male
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Dates
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Enumeration Date | 10/09/2023
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Last Update Date | 10/09/2023
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Provider Practice Location Address
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Address Line | 2250 SOQUEL AVE
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City | SANTA CRUZ
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State | CA
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Zip | 95062-1402
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Country | US
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Telephone | 469-927-7668
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Fax |
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Provider Business Mailing Address
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Address Line | 3402 WYOMING BLVD NE BLDG 340206
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-4400
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Country | US
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Telephone | 469-927-7668
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number | 95352338
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License Number State | CA
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