Provider Demographics
NPI:1346053139
Name:ALTAREB, KHALIL
Entity type:Individual
Prefix:
First Name:KHALIL
Middle Name:
Last Name:ALTAREB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1444 BANDONI DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95206-3866
Mailing Address - Country:US
Mailing Address - Phone:510-860-1517
Mailing Address - Fax:
Practice Address - Street 1:1444 BANDONI DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95206-3866
Practice Address - Country:US
Practice Address - Phone:510-860-1517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No347E00000XTransportation ServicesTransportation Broker