1013702679 NPI number — REEM MOHAMMAD KHEIRO ALSHIYYAB MD

Table of content: REEM MOHAMMAD KHEIRO ALSHIYYAB MD (NPI 1013702679)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013702679 NPI number — REEM MOHAMMAD KHEIRO ALSHIYYAB MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALSHIYYAB
Provider First Name:
REEM
Provider Middle Name:
MOHAMMAD KHEIRO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1013702679
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8030 LA MESA BLVD UNIT 491
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA MESA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91942-0335
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-996-4490
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4439 STATE ROUTE 159
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
CHILLICOTHEE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-779-7070
Provider Business Practice Location Address Fax Number:
740-779-8449
Provider Enumeration Date:
04/14/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  57.258994 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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