Provider Demographics
NPI:1952615916
Name:OUSA, SAL JAMIL
Entity Type:Individual
Prefix:
First Name:SAL
Middle Name:JAMIL
Last Name:OUSA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:SALAH
Other - Middle Name:JAMIL
Other - Last Name:RAZZOUKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1429 VISTA GRANDE RD
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-3677
Mailing Address - Country:US
Mailing Address - Phone:619-772-2950
Mailing Address - Fax:
Practice Address - Street 1:1429 VISTA GRANDE RD
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-3677
Practice Address - Country:US
Practice Address - Phone:619-772-2950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-02
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver