Individual
HUSAM ISSA BADAWIYA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
17227 GROVE DR, RIVERSIDE, CA 92503-6749
(951) 353-0698
Mailing address
17227 GROVE DR, RIVERSIDE, CA 92503-6749
(951) 353-0698
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
6PDZ412
CA
347C00000X
Private Vehicle
6SJH640
CA
Other
Enumeration date
04/15/2014
Last updated
04/15/2014
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