Provider Demographics
NPI:1427390418
Name:AYAD M GHARGHOURY MD INC
Entity Type:Organization
Organization Name:AYAD M GHARGHOURY MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:AYAD
Authorized Official - Middle Name:M
Authorized Official - Last Name:GHARGHOURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-322-5124
Mailing Address - Street 1:58383 29 PALMS HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-5890
Mailing Address - Country:US
Mailing Address - Phone:760-228-5864
Mailing Address - Fax:760-365-9184
Practice Address - Street 1:58383 29 PALMS HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-5890
Practice Address - Country:US
Practice Address - Phone:760-228-5864
Practice Address - Fax:760-365-9184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-18
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50604174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A506040Medicare PIN