Basic Information
Provider Information
NPI: 1053604918
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AL-SHUWAYKH
FirstName: HARITH
MiddleName: S HAMMOODI
NamePrefix: MR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3400 DATA DR
Address2: PHYSICIAN SUPPORT SERVICES
City: RANCHO CORDOVA
State: CA
PostalCode: 956707956
CountryCode: US
TelephoneNumber: 9163792948
FaxNumber: 9168587065
Practice Location
Address1: 6501 COYLE AVENUE
Address2:  
City: CARMICHAEL
State: CA
PostalCode: 95608
CountryCode: US
TelephoneNumber: 9165375079
FaxNumber: 9169663189
Other Information
ProviderEnumerationDate: 05/25/2011
LastUpdateDate: 12/28/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/28/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208M00000XA130669CAY Allopathic & Osteopathic PhysiciansHospitalist 
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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