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1558790014 NPI number — TAREQ AHMAD AL MUGHAZZEZ

NPI Number: 1558790014
Health Care Provider/Practitioner: TAREQ AHMAD AL MUGHAZZEZ

Information about “1558790014” NPI (TAREQ AHMAD AL MUGHAZZEZ) exists in 1558790014 in HTML format HTML  |  1558790014 in plain Text format TXT  |  1558790014 in PDF (Portable Document Format) PDF  |  1558790014 in an XML format XML  formats.

NPI Number : 1558790014 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1558790014",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "AL MUGHAZZEZ",
    "FirstName": "TAREQ",
    "MiddleName": "AHMAD",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4661 RED HILL WAY",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "TURLOCK",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "95382-7474",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "650-743-3235",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1080 W F ST STE D",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "OAKDALE",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "95361-3677",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "209-847-2226",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/05/2013",
    "LastUpdateDate": "10/17/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "183500000X",
        "TaxonomyName": "Pharmacist",
        "LicenseNumber": "67372",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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