1184084865 NPI number — MOHAMMAD YOUSEF ALKHATIB MD INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184084865 NPI number — MOHAMMAD YOUSEF ALKHATIB MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOHAMMAD YOUSEF ALKHATIB MD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184084865
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
47750 ADAMS ST APT 1223
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA QUINTA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92253-7107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-863-1592
Provider Business Mailing Address Fax Number:
866-544-2050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
79405 HIGHWAY 111 STE 9-334
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA QUINTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92253-8300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-863-1592
Provider Business Practice Location Address Fax Number:
866-544-2050
Provider Enumeration Date:
02/24/2016

Additional Information

Authorized Official

Authorized Official Last Name:
ALKHATIB
Authorized Official First Name:
MOHAMMAD
Authorized Official Middle Name:
Y
Authorized Official Title or Position:
PRESIDENT/PHYSICIAN
Authorized Official Telephone Number:
760-619-7656

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X , with the licence number:  A117007 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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