Provider Demographics
NPI:1538475512
Name:NADDOUR, CHAZA A
Entity Type:Individual
Prefix:
First Name:CHAZA
Middle Name:A
Last Name:NADDOUR
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 1:6532 REFLECTION DR
Mailing Address - Street 2:2152
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124
Mailing Address - Country:US
Mailing Address - Phone:619-563-7600
Mailing Address - Fax:
Practice Address - Street 1:3650 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116
Practice Address - Country:US
Practice Address - Phone:619-563-0802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61562183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist