1629089073 NPI number — GHASSAN SAID TOOMA MD

Table of content: GHASSAN SAID TOOMA MD (NPI 1629089073)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629089073 NPI number — GHASSAN SAID TOOMA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOOMA
Provider First Name:
GHASSAN
Provider Middle Name:
SAID
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:
1629089073
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/16/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
341 MAGNOLIA AVE STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORONA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92879-3331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-735-6060
Provider Business Mailing Address Fax Number:
951-735-4510

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
341 MAGNOLIA AVE
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
CORONA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92879-3331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-735-6060
Provider Business Practice Location Address Fax Number:
951-735-4510
Provider Enumeration Date:
08/11/2006

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: 207X00000X , with the licence number:  G64601 , 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: 200034606 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00G646010 . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00G646010 . This is a "BLUE CROSS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00G646010 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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