Basic Information
| Provider Information | |||||||||
| NPI: | 1669655007 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SADDOUK | ||||||||
| FirstName: | YAMINE | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD, DO | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | SADDOUK | ||||||||
| OtherFirstName: | ABDERRAHMANE | ||||||||
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| OtherCredential: | MD, DO | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2525 W BERYL AVE | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850211606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024247967 | ||||||||
| FaxNumber: | 6023714960 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 S CRISMON RD | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4803749227 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2007 | ||||||||
| LastUpdateDate: | 01/14/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 005075 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.