1164478855 NPI number — REHANA S. BAQAI M.D.

Table of content: REHANA S. BAQAI M.D. (NPI 1164478855)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164478855 NPI number — REHANA S. BAQAI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAQAI
Provider First Name:
REHANA
Provider Middle Name:
S.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1164478855
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18111 BROOKHURST ST
Provider Second Line Business Mailing Address:
SUITE # 6100
Provider Business Mailing Address City Name:
FOUNTAIN VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92708-6728
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-698-0300
Provider Business Mailing Address Fax Number:
714-698-0313

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
260 E ONTARIO AVE
Provider Second Line Business Practice Location Address:
SUITE # 101
Provider Business Practice Location Address City Name:
CORONA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92879-3506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-371-2411
Provider Business Practice Location Address Fax Number:
951-284-0177
Provider Enumeration Date:
05/25/2006

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: 174400000X , with the licence number:  A48182 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X , with the licence number: A48182 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: ZZZ64478Z . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: ZZZ05040Z . This is a "BLUE SHEILD" identifier . This identifiers is of the category "OTHER".
  • Identifier: GR0093942 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZ05039Z . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: GR0093941 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GR0093940 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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