Provider Demographics
NPI:1821633355
Name:AL-FAYYAD, LUBNA
Entity Type:Individual
Prefix:
First Name:LUBNA
Middle Name:
Last Name:AL-FAYYAD
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 1:26710 BIRCH HILL WAY
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-3302
Mailing Address - Country:US
Mailing Address - Phone:408-348-8832
Mailing Address - Fax:
Practice Address - Street 1:2069 CAMDEN AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-2024
Practice Address - Country:US
Practice Address - Phone:408-559-1450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58326183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist