1023523099 NPI number — TARIQ HILAL, DO INC.

Table of content: STANLEY DESIR BA (NPI 1710394531)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023523099 NPI number — TARIQ HILAL, DO INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TARIQ HILAL, DO INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SOUTH COAST SPINE, SPORTS, AND REHABILITATION MEDICINE
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023523099
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11769
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTMINSTER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92685-1769
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-553-4034
Provider Business Mailing Address Fax Number:
562-534-2604

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3771 KATELLA AVE STE 107
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ALAMITOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90720-3111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-553-4034
Provider Business Practice Location Address Fax Number:
562-534-2604
Provider Enumeration Date:
12/12/2017

Additional Information

Authorized Official

Authorized Official Last Name:
HILAL
Authorized Official First Name:
TARIQ
Authorized Official Middle Name:
I
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
714-553-4034

Provider Taxonomy Codes

  • Taxonomy code: 2081P2900X , with the licence number:  12335 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 20A15622 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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