Provider Demographics
NPI:1871523019
Name:AICHOURI, ABDELLATIF A (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:ABDELLATIF
Middle Name:A
Last Name:AICHOURI
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 S HIGUERA ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-6998
Mailing Address - Country:US
Mailing Address - Phone:805-541-5505
Mailing Address - Fax:805-541-5075
Practice Address - Street 1:3220 S HIGUERA ST
Practice Address - Street 2:SUITE 205
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-6998
Practice Address - Country:US
Practice Address - Phone:805-541-5505
Practice Address - Fax:805-541-5075
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA874352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
0007984583OtherAETNA PIN
CA351335OtherMANAGED HEALTH CARE PIN