Basic Information
| Provider Information | |||||||||
| NPI: | 1699055566 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALHAKIM | ||||||||
| FirstName: | MANAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 W THOMAS RD STE 900 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850134223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024063540 | ||||||||
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| Practice Location | |||||||||
| Address1: | 500 W THOMAS RD STE 900 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850134223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024063540 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2011 | ||||||||
| LastUpdateDate: | 08/24/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | R72910 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | R72910 | 01 | AZ | TRAINING PERMIT | OTHER |