MEDICARE: DR. HAYTHAM ALJOUDI MD

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	207R00000X	Internal Medicine Physician	22763	WV
2	207R00000X	Internal Medicine Physician	MD00047415	WA
3	207RC0000X	Cardiovascular Disease Physician	22763	WV
4	207RC0000X	Cardiovascular Disease Physician	C150276	CA

General Provider Information

NPI Number	:	1699969287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HAYTHAM ALJOUDI MD

Provider Business Mailing Address
First Line	:	1801 E MARCH LN STE D400
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95210-6675
Country	:	US
Telephone Number	:	209-464-3615
Fax Number	:	304-691-8510

Provider Business Practice Location Address
First Line	:	1801 E MARCH LN STE D400
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95210-6675
Country	:	US
Telephone Number	:	209-464-3615
Fax Number	:

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

Provider Enumeration Date	:	08/28/2007
Last Update Date	:	03/02/2020

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