1376705418 NPI number — SHOKRY NABEEL LAWANDY D.O.

Table of content: SHOKRY NABEEL LAWANDY D.O. (NPI 1376705418)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376705418 NPI number — SHOKRY NABEEL LAWANDY D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAWANDY
Provider First Name:
SHOKRY
Provider Middle Name:
NABEEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1376705418
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19069 VAN BUREN BLVD
Provider Second Line Business Mailing Address:
SUITE 114 UNIT # 422
Provider Business Mailing Address City Name:
RIVERSIDE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-402-4017
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6555 COYLE AVENUE
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
CARMICHAEL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-241-9677
Provider Business Practice Location Address Fax Number:
916-436-4288
Provider Enumeration Date:
06/30/2008

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: 207T00000X , with the licence number:  20A10863 , 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: 1376705418 . This is a "NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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