Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN1001X | Nutrition | 10642 | CA |
N | 111NR0200X | Radiology | 10642 | CA |
N | 213ER0200X | Radiology | 10642 | CA |
N | 111NS0005X | Chiropractic Sports Physician | 10642 | CA |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 10642 | CA |
NPI | 1245339159 |
---|---|
Provider Name | Samir B Faragallah |
First Address | El Cajon, CA 92021-4862 |
Second Address | El Cajon, CA 92021-4862 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10642 | CA STATE LC # CHIROPRACTI (01) | CA |
765 | AZ.STATE CHIROPRACTIC LC. (01) | AZ |
DC0106420 | (05) | CA |
DC0106420 | BLUE SHIELD OF CA (01) | CA |