Provider Demographics
NPI:1043855208
Name:HISHAM ABUKAMLEH MD. INC
Entity type:Organization
Organization Name:HISHAM ABUKAMLEH MD. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:HISHAM
Authorized Official - Middle Name:JIHAD
Authorized Official - Last Name:ABUKAMLEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-515-4003
Mailing Address - Street 1:18182 US HIGHWAY 18 STE 107
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2200
Mailing Address - Country:US
Mailing Address - Phone:760-515-4003
Mailing Address - Fax:760-515-4503
Practice Address - Street 1:18144 US HIGHWAY 18 STE 140
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2219
Practice Address - Country:US
Practice Address - Phone:760-515-4003
Practice Address - Fax:760-515-4503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-12
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1144689647Medicaid