1427390418 NPI number — AYAD M GHARGHOURY MD INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427390418 NPI number — AYAD M GHARGHOURY MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AYAD M GHARGHOURY MD 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:
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:
1427390418
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
58383 29 PALMS HWY
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
YUCCA VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92284-5890
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-228-5864
Provider Business Mailing Address Fax Number:
760-365-9184

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
58383 29 PALMS HWY
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
YUCCA VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92284-5890
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-228-5864
Provider Business Practice Location Address Fax Number:
760-365-9184
Provider Enumeration Date:
03/18/2013

Additional Information

Authorized Official

Authorized Official Last Name:
GHARGHOURY
Authorized Official First Name:
AYAD
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
760-322-5124

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  A50604 , 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)





Copyright © 2007-2026 www.npivalidator.com