Basic Information
| Provider Information | |||||||||
| NPI: | 1104282375 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SALAM YATOOMA, M.D., INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5555 GROSSMONT CENTER DR | ||||||||
| Address2: | |||||||||
| City: | LA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919423019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8886648297 | ||||||||
| FaxNumber: | 6197404204 | ||||||||
| Practice Location | |||||||||
| Address1: | 2030 COLINA GRANDE | ||||||||
| Address2: | |||||||||
| City: | EL CAJON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920193591 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6197290559 | ||||||||
| FaxNumber: | 6197404204 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2016 | ||||||||
| LastUpdateDate: | 01/04/2016 | ||||||||
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| AuthorizedOfficialLastName: | YATOOMA | ||||||||
| AuthorizedOfficialFirstName: | SALAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8886648297 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A102344 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.