Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | DC26862 | CA |
NPI | 1083953566 |
---|---|
Provider Name | Elmostafa Elkhiar |
First Address | Ontario, CA 91762-3500 |
Second Address | Ontario, CA 91762-3500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2013 |
Last Update Date | 04/02/2013 |