1639196371 NPI number — DR. RAAD ANDREW AL-SHAIKH M.D.

Table of content: DR. RAAD ANDREW AL-SHAIKH M.D. (NPI 1639196371)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639196371 NPI number — DR. RAAD ANDREW AL-SHAIKH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AL-SHAIKH
Provider First Name:
RAAD
Provider Middle Name:
ANDREW
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1639196371
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/20/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10556 COMBIE RD
Provider Second Line Business Mailing Address:
PMB 6618
Provider Business Mailing Address City Name:
AUBURN
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95602-8908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-885-9191
Provider Business Mailing Address Fax Number:
530-823-9119

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11720 EDUCATION ST STE 5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95602-2419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-885-9191
Provider Business Practice Location Address Fax Number:
530-823-9119
Provider Enumeration Date:
07/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  A63005 , 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)

  • Identifier: 00A630050 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".