Individual
AHMAD MAHMOUD QUDAIESAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
555 E HARDY ST, INGLEWOOD, CA 90301-4011
(310) 680-8536
Mailing address
898 N PACIFIC COAST HWY STE 600, EL SEGUNDO, CA 90245-2747
(310) 379-2134
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
95010937
CA
Other
Enumeration date
01/23/2019
Last updated
01/23/2019
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