Provider Demographics
NPI:1477346252
Name:MUDAWAR, DIALA RAED (PHARMD)
Entity type:Individual
Prefix:
First Name:DIALA
Middle Name:RAED
Last Name:MUDAWAR
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6050 PLACER WEST DR APT 211
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-4607
Mailing Address - Country:US
Mailing Address - Phone:415-939-2870
Mailing Address - Fax:
Practice Address - Street 1:5090 FOOTHILLS BLVD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-6517
Practice Address - Country:US
Practice Address - Phone:916-783-1355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-26
Last Update Date:2025-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90661183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist