Provider Demographics
NPI:1730316373
Name:SALAMAH, ABDEL FATTAH (OWNER)
Entity Type:Individual
Prefix:MR
First Name:ABDEL
Middle Name:FATTAH
Last Name:SALAMAH
Suffix:
Gender:M
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13319 LETTERMAN ST
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-3711
Mailing Address - Country:US
Mailing Address - Phone:909-210-3265
Mailing Address - Fax:951-247-4759
Practice Address - Street 1:13319 LETTERMAN ST
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-3711
Practice Address - Country:US
Practice Address - Phone:909-210-3265
Practice Address - Fax:951-247-4759
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC3923529171R00000X, 172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No171R00000XOther Service ProvidersInterpreter