Provider Demographics
NPI:1083790513
Name:GHALY, GAMAL F (MD)
Entity Type:Individual
Prefix:
First Name:GAMAL
Middle Name:F
Last Name:GHALY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GAMAL
Other - Middle Name:F
Other - Last Name:GHALY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14114 BUSINESS CENTER DR STE G
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-9113
Mailing Address - Country:US
Mailing Address - Phone:951-656-5333
Mailing Address - Fax:951-656-6789
Practice Address - Street 1:14114 BUSINESS CENTER DR. STE. G
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-9113
Practice Address - Country:US
Practice Address - Phone:951-656-5333
Practice Address - Fax:951-656-6789
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44392207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A443920Medicare UPIN