1346126711 NPI number — LARAH JAMILA HAJ-DIAB LARAH DIAB

Table of content: LARAH JAMILA HAJ-DIAB LARAH DIAB (NPI 1346126711)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346126711 NPI number — LARAH JAMILA HAJ-DIAB LARAH DIAB

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAJ-DIAB
Provider First Name:
LARAH
Provider Middle Name:
JAMILA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LARAH DIAB
Provider Gender Code:
F

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:
1346126711
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/12/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44494 WHITE PINE CIR E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTHVILLE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48168-4346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-497-9138
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4021 MILLER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLINT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48507-1231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-292-0719
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/12/2025

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: 122300000X , with the licence number:  2901602734 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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