Provider Demographics
NPI:1073755476
Name:ROBBY T AYOUB MD PROF MEDICAL CORP
Entity Type:Organization
Organization Name:ROBBY T AYOUB MD PROF MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBBY
Authorized Official - Middle Name:T
Authorized Official - Last Name:AYOUB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-432-1800
Mailing Address - Street 1:17870 NEWHOPE ST
Mailing Address - Street 2:SUITE 104-546
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-5439
Mailing Address - Country:US
Mailing Address - Phone:714-847-6900
Mailing Address - Fax:714-847-3900
Practice Address - Street 1:8201 NEWMAN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-7020
Practice Address - Country:US
Practice Address - Phone:714-847-6900
Practice Address - Fax:714-847-3900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-31
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X, 207RC0200X, 207RS0012X
CAA102841207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACC648AOtherPTAN
1396958237Medicare UPIN