Provider Demographics
NPI:1275719403
Name:RAYHANABAD, JESSICA A (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:RAYHANABAD
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12340 SEAL BEACH BLVD STE B421
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-2792
Mailing Address - Country:US
Mailing Address - Phone:562-206-1312
Mailing Address - Fax:562-206-1314
Practice Address - Street 1:3791 KATELLA AVE STE 201
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2016
Practice Address - Country:US
Practice Address - Phone:562-206-1312
Practice Address - Fax:562-206-1314
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-17
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA99470208600000X
CAA99470208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery