Provider Demographics
NPI:1417533654
Name:INTELLICHOICE MEDICAL, APC
Entity Type:Organization
Organization Name:INTELLICHOICE MEDICAL, APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUHAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:JAFREY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-717-4566
Mailing Address - Street 1:3830 VALLEY CENTRE DR STE 705-832
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-3320
Mailing Address - Country:US
Mailing Address - Phone:206-445-9978
Mailing Address - Fax:
Practice Address - Street 1:4295 JURUPA ST STE 116
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-1430
Practice Address - Country:US
Practice Address - Phone:206-445-9978
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty