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General NPI Number Information
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NPI Number | 1740492214
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Entity Type | Individual
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Provider Name | BADER ABU GHALYOUN MD
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Gender | Male
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 06/25/2020
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Provider Practice Location Address
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Address Line | 1801 E MARCH LN
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City | STOCKTON
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State | CA
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Zip | 95210-6629
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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 | 209-464-1537
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 24179
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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 | 24179
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License Number State | WV
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Taxonomy #3
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | C169074
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License Number State | CA
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