| Raouf A Kayaleh Md Prof Medical Corp | |
|
1125 E 17th St Suite E-109 Santa Ana CA 92701-2201 | |
| (909) 374-0804 | |
| Not Available |
| Full Name | Raouf A Kayaleh Md Prof Medical Corp |
|---|---|
| Speciality | Internal Medicine |
| Location | 1125 E 17th St, Santa Ana, California |
| Authorized Official Name and Position | Raouf Antoine Kayaleh (OWNER) |
| Authorized Official Contact | 7142790711 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Raouf A Kayaleh Md Prof Medical Corp 1125 E 17th St Suite E-109 Santa Ana CA 92701-2201 Ph: (909) 374-0804 | Raouf A Kayaleh Md Prof Medical Corp 1125 E 17th St Suite E-109 Santa Ana CA 92701-2201 Ph: (909) 374-0804 |
| NPI Number | 1770902900 |
|---|---|
| Provider Enumeration Date | 04/15/2014 |
| Last Update Date | 06/19/2015 |
| Medicare PECOS PAC ID | 7416171053 |
|---|---|
| Medicare Enrollment ID | O20140620001830 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770902900 | NPI | - | NPPES |
| 00C414491 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | C41449 (California) | Primary |
| 207RC0200X | Internal Medicine - Critical Care Medicine | C41449 (California) | Secondary |
| Provider Name | Raouf A Kayaleh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1942311246 PECOS PAC ID: 5294629853 Enrollment ID: I20040212000862 |
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