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General NPI Number Information
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NPI Number | 1821612565
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Entity Type | Organization
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Legal Business Name | ALMOUTAZ BELLAH SHAKALLY MD, INC
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Dates
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Enumeration Date | 05/28/2020
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Last Update Date | 04/25/2024
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Provider Practice Location Address
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Address Line | 802 MAGNOLIA AVE STE 200
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City | CORONA
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State | CA
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Zip | 92879-3144
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Country | US
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Telephone | 951-444-7006
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Fax | 909-247-3340
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Provider Business Mailing Address
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Address Line | 802 MAGNOLIA AVE STE 200
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City | CORONA
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State | CA
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Zip | 92879-3144
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Country | US
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Telephone | 951-444-7006
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Fax | 909-247-3340
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Authorized Official
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Title or Position | OWNER
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Name | ALMOUTAZ BELLAH SHAKALLY
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Credential | MD
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Telephone | 951-444-7006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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