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General NPI Number Information
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NPI Number | 1881955367
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Entity Type | Organization
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Legal Business Name | KHALILULLAH ATAI MEDICAL AND WELLNESS CENTER INC.
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Dates
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Enumeration Date | 05/31/2012
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Last Update Date | 05/31/2012
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Provider Practice Location Address
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Address Line | 15051 HESPERIAN BLVD
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City | SAN LEANDRO
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State | CA
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Zip | 94578-3536
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Country | US
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Telephone | 510-278-4800
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Fax | 510-651-0695
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Provider Business Mailing Address
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Address Line | 15051 HESPERIAN BLVD
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City | SAN LEANDRO
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State | CA
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Zip | 94578-3536
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Country | US
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Telephone | 510-278-4800
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Fax | 510-651-0695
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | DR. SOLIMAN SPARTA ATAI
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Credential | M.D.
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Telephone | 510-278-4800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A113224
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License Number State | CA
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