Provider Demographics
NPI:1720057623
Name:POWELL, NAIMAH D (MD)
Entity Type:Individual
Prefix:DR
First Name:NAIMAH
Middle Name:D
Last Name:POWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:425 DIAMOND DRIVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530
Mailing Address - Country:US
Mailing Address - Phone:951-674-8779
Mailing Address - Fax:951-674-1403
Practice Address - Street 1:425 DIAMOND DRIVE
Practice Address - Street 2:SUITE 105
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530
Practice Address - Country:US
Practice Address - Phone:951-674-8779
Practice Address - Fax:951-674-1403
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG72993207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG729931Medicaid
CAF24057Medicare UPIN
CAG729930Medicare ID - Type Unspecified