MEDICARE: HUMAM ALWAN

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	172A00000X	Driver	Y9189419	CA

General Provider Information

NPI Number	:	1265947790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HUMAM ALWAN

Provider Business Mailing Address
First Line	:	11055 WEATHERWOOD TER
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92131-2670
Country	:	US
Telephone Number	:	858-267-9994
Fax Number	:

Provider Business Practice Location Address
First Line	:	11055 WEATHERWOOD TER
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92131-2670
Country	:	US
Telephone Number	:	858-267-9994
Fax Number	:

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

Provider Enumeration Date	:	12/06/2017
Last Update Date	:	12/06/2017

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Directions to “ HUMAM ALWAN ” Practice Location

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