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General NPI Number Information
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NPI Number | 1699969287
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Entity Type | Individual
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Provider Name | HAYTHAM ALJOUDI MD
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Gender | Male
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Dates
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Enumeration Date | 08/28/2007
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Last Update Date | 03/02/2020
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Provider Practice Location Address
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Address Line | 1801 E MARCH LN STE D400
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City | STOCKTON
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State | CA
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Zip | 95210-6675
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Country | US
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Telephone | 209-464-3615
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Fax |
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Provider Business Mailing Address
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Address Line | 1801 E MARCH LN STE D400
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City | STOCKTON
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State | CA
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Zip | 95210-6675
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Country | US
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Telephone | 209-464-3615
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Fax | 304-691-8510
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 22763
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD00047415
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 22763
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License Number State | WV
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Taxonomy #4
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | C150276
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License Number State | CA
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