1730529694 NPI number — LAITH TAWFEEQ ALRESHAID MD

Table of content: LAITH TAWFEEQ ALRESHAID MD (NPI 1730529694)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730529694 NPI number — LAITH TAWFEEQ ALRESHAID MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALRESHAID
Provider First Name:
LAITH
Provider Middle Name:
TAWFEEQ
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1730529694
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4499 VIA MARISOL
Provider Second Line Business Mailing Address:
APT 139
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90042-5147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-437-1991
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 S FREMONT AVE BLDG A9
Provider Second Line Business Practice Location Address:
OFFICE OF REVENUE CYCLE MANAGEMENT PROVIDER ENROLLMEN
Provider Business Practice Location Address City Name:
ALHAMBRA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91803-8800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-457-5848
Provider Business Practice Location Address Fax Number:
626-457-4125
Provider Enumeration Date:
06/25/2013

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: 207P00000X , with the licence number:  4301103709 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: A144334 , 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: 1730529694 . This is a "MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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