Provider Demographics
NPI:1073896544
Name:ABOU RJAILI, GEORGES (MD)
Entity Type:Individual
Prefix:
First Name:GEORGES
Middle Name:
Last Name:ABOU RJAILI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 BROCKTON AVE
Mailing Address - Street 2:STE 203
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-4090
Mailing Address - Country:US
Mailing Address - Phone:951-686-3600
Mailing Address - Fax:951-686-1162
Practice Address - Street 1:4500 BROCKTON AVE
Practice Address - Street 2:STE 203
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-4090
Practice Address - Country:US
Practice Address - Phone:951-686-3600
Practice Address - Fax:951-686-1162
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY7309604207RC0000X
TN48951207RC0000X
CAA140214207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1629016399OtherNPI