Individual provider Active NPI

Tahany Rezkalla Habib Sadek

  • Pharmacist
  • San Diego, CA
National Provider Identifier
1770209470
Registry record updated Oct 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
87067 Issued in CA
Practice address
3030 Alta View Dr Unit C205
San Diego, CA 92139-3384
Phone
(310) 424-0451
NPI assigned
Oct 13, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 13, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PharmacistGroup: 193400000X SINGLE SPECIALTY GROUP 183500000X 87067 CA Primary

Addresses

Primary practice location

3030 Alta View Dr Unit C205
San Diego, CA 92139-3384

Mailing address

3030 Alta View Dr Unit C205
San Diego, CA 92139-3384
Phone (310) 424-0451

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL email Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
87067CAMDMassage Therapist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1665619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665619200000",
    "number": "1770209470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3030 ALTA VIEW DR UNIT C205",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921393384",
            "telephone_number": "310-424-0451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3030 ALTA VIEW DR UNIT C205",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921393384",
            "telephone_number": "310-424-0451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SADEK",
        "first_name": "TAHANY",
        "middle_name": "REZKALLA HABIB",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-10-13",
        "last_updated": "2022-10-13",
        "certification_date": "2022-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": "CA",
            "license": "87067",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "email",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "san diego",
            "city": "san diego",
            "state": "CA",
            "country_code": "US",
            "postal_code": "92139",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.