Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | A53067 | CA |
NPI | 1164510285 |
---|---|
Provider Name | Saad Matti Bakhaya |
First Address | Lancaster, CA 93534 |
Second Address | Lancaster, CA 93534 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 17/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F69099 | (02) |