Provider Demographics
NPI:1104554443
Name:ABU RAJAB TAMIMI, SUZAN
Entity type:Individual
Prefix:
First Name:SUZAN
Middle Name:
Last Name:ABU RAJAB TAMIMI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10787 SORNOWAY LN
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-5518
Mailing Address - Country:US
Mailing Address - Phone:858-231-4963
Mailing Address - Fax:
Practice Address - Street 1:2000 DRISCOLL RD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-4446
Practice Address - Country:US
Practice Address - Phone:510-770-8571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-14
Last Update Date:2022-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82585183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist