Provider Demographics
NPI:1053482752
Name:RAEF M ELSANADI MD INC A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:RAEF M ELSANADI MD INC A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAEF
Authorized Official - Middle Name:M
Authorized Official - Last Name:ELSANADI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-364-3582
Mailing Address - Street 1:27800 MEDICAL CTR RD
Mailing Address - Street 2:212
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691
Mailing Address - Country:US
Mailing Address - Phone:949-364-3582
Mailing Address - Fax:949-364-1472
Practice Address - Street 1:27800 MEDICAL CTR RD
Practice Address - Street 2:212
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691
Practice Address - Country:US
Practice Address - Phone:949-364-3582
Practice Address - Fax:949-364-3582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18189Medicare ID - Type Unspecified