MEDICARE: FADI MATLOOB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	72881	CA

General Provider Information

NPI Number	:	1225400385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FADI MATLOOB

Provider Business Mailing Address
First Line	:	927 S CHINA LAKE BLVD
Second Line	:
City	:	RIDGECREST
State	:	CA
Zip	:	93555-6315
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	927 S CHINA LAKE BLVD
Second Line	:
City	:	RIDGECREST
State	:	CA
Zip	:	93555-6315
Country	:	US
Telephone Number	:	760-384-4020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2015
Last Update Date	:	10/28/2015

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Directions to “ FADI MATLOOB ” Practice Location

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