Provider Demographics
NPI:1265898126
Name:DAKKAK, NOOR
Entity type:Individual
Prefix:
First Name:NOOR
Middle Name:
Last Name:DAKKAK
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 1:20537 E CALORA ST
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-1240
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1433 N HOLLENBECK AVE STE 101
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91722-1558
Practice Address - Country:US
Practice Address - Phone:626-214-3675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-07
Last Update Date:2021-08-28
Deactivation Date:2019-02-06
Deactivation Code:
Reactivation Date:2019-02-13
Provider Licenses
StateLicense IDTaxonomies
CA56422363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant