Provider Demographics
NPI:1396238184
Name:ALNAJJAR, DELAIR LUCAS (MD)
Entity type:Individual
Prefix:
First Name:DELAIR
Middle Name:LUCAS
Last Name:ALNAJJAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 743
Mailing Address - Street 2:
Mailing Address - City:BONSALL
Mailing Address - State:CA
Mailing Address - Zip Code:92003-0743
Mailing Address - Country:US
Mailing Address - Phone:248-840-5871
Mailing Address - Fax:
Practice Address - Street 1:41540 WINCHESTER RD
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-4877
Practice Address - Country:US
Practice Address - Phone:951-365-5585
Practice Address - Fax:951-404-7074
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA181114207Q00000X
MI4301115471390200000X
MI4301505557207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty