Provider Demographics
NPI:1093987547
Name:W. WASEF ATIYA
Entity Type:Organization
Organization Name:W. WASEF ATIYA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WASEF
Authorized Official - Middle Name:Y
Authorized Official - Last Name:ATIYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-658-7284
Mailing Address - Street 1:1011 E DEVONSHIRE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-3033
Mailing Address - Country:US
Mailing Address - Phone:951-658-7284
Mailing Address - Fax:951-766-5004
Practice Address - Street 1:1011 E DEVONSHIRE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-3033
Practice Address - Country:US
Practice Address - Phone:951-658-7284
Practice Address - Fax:951-766-5004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32839261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0087351Medicaid