Provider Demographics
NPI:1003535097
Name:HEALTH AVE CLINIC INC
Entity Type:Organization
Organization Name:HEALTH AVE CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAYYAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-499-5006
Mailing Address - Street 1:250 E CHASE AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-6305
Mailing Address - Country:US
Mailing Address - Phone:619-499-5006
Mailing Address - Fax:
Practice Address - Street 1:250 E CHASE AVE STE 109
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-6305
Practice Address - Country:US
Practice Address - Phone:619-499-5006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty