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Individual

DR. MOHAMMAD S KANAKRIYEH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
350 E VANDERBILT WAY, STE A, SAN BERNARDINO, CA 92408
(909) 886-5200
(909) 382-9017
Mailing address
350 E VANDERBILT WAY, STE A, SAN BERNARDINO, CA 92408
(909) 886-5200
(909) 382-9017

Taxonomy

Speciality
Code
Description
License number
State
2080P0202X
Pediatric Cardiology Physician
Primary
A42526
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00A425260
CA
01
330698865
BLUE CROSS
CA
01
ZZZ51351Z
BLUE SHIELD
CA
Enumeration date
10/13/2006
Last updated
02/12/2019
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