MEDICARE: DIYA K ALNAJJAR MB.CHB.

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	390200000X	Student in an Organized Health Care Education/Training Program
2	208600000X	Surgery Physician	ME160391	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396232328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIYA K ALNAJJAR MB.CHB.

Provider Business Mailing Address
First Line	:	40124 HIGHWAY 27 STE 104
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33837-5905
Country	:	US
Telephone Number	:	863-421-7626
Fax Number	:

Provider Business Practice Location Address
First Line	:	17803 LA CANTERA TER APT 17803
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78256-2545
Country	:	US
Telephone Number	:	210-862-6141
Fax Number	:

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

Provider Enumeration Date	:	04/16/2018
Last Update Date	:	08/02/2023

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