Provider Demographics
NPI:1104282375
Name:SALAM YATOOMA, M.D., INC.
Entity type:Organization
Organization Name:SALAM YATOOMA, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SALAM
Authorized Official - Middle Name:
Authorized Official - Last Name:YATOOMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-664-8297
Mailing Address - Street 1:5555 GROSSMONT CENTER DR
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3019
Mailing Address - Country:US
Mailing Address - Phone:888-664-8297
Mailing Address - Fax:619-740-4204
Practice Address - Street 1:2030 COLINA GRANDE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-3591
Practice Address - Country:US
Practice Address - Phone:619-729-0559
Practice Address - Fax:619-740-4204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA102344207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty