Basic Information
| Provider Information | |||||||||
| NPI: | 1881176543 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALDULEME | ||||||||
| FirstName: | WESAM | ||||||||
| MiddleName: | HAKKI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3821 CAYMAN CT | ||||||||
| Address2: | |||||||||
| City: | ANTELOPE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958434518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164954655 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4860 Y ST | ||||||||
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| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958172307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167347041 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2018 | ||||||||
| LastUpdateDate: | 08/29/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 227900000X | 39090 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Registered |
ID Information
| ID | Type | State | Issuer | Description | 00029828100 | 01 | CA | WESTERN HEALTH ADVANTAGE | OTHER |