Provider Demographics
NPI:1437644143
Name:ALJANABI, LINA
Entity Type:Individual
Prefix:
First Name:LINA
Middle Name:
Last Name:ALJANABI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 BARTON RD APT 906
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-4392
Mailing Address - Country:US
Mailing Address - Phone:347-930-9436
Mailing Address - Fax:
Practice Address - Street 1:1601 BARTON RD APT 906
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4392
Practice Address - Country:US
Practice Address - Phone:347-930-9436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102582122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist