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General NPI Number Information
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NPI Number | 1629030895
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Entity Type | Individual
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Provider Name | SA'D KHALIL TUQAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/04/2006
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Last Update Date | 02/20/2020
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Provider Practice Location Address
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Address Line | 2250 S MAIN ST SUITE 201
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City | CORONA
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State | CA
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Zip | 92882-5302
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Country | US
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Telephone | 951-734-4880
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Fax | 951-734-7963
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Provider Business Mailing Address
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Address Line | 1901 TOWN AND COUNTRY DR STE 104
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City | NORCO
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State | CA
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Zip | 92860-3611
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Country | US
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Telephone | 951-808-6240
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Fax | 951-738-9954
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | C37812
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License Number State | CA
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