Provider Demographics
NPI:1477929974
Name:TALAL R. MUHTASEB M.D. INC
Entity Type:Organization
Organization Name:TALAL R. MUHTASEB M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TALAL
Authorized Official - Middle Name:RAJAB
Authorized Official - Last Name:MUHTASEB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-687-9791
Mailing Address - Street 1:PO BOX 2164
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92051-2164
Mailing Address - Country:US
Mailing Address - Phone:760-687-9791
Mailing Address - Fax:760-730-5740
Practice Address - Street 1:3998 VISTA WAY
Practice Address - Street 2:SUITE C
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056
Practice Address - Country:US
Practice Address - Phone:760-687-9791
Practice Address - Fax:760-730-5740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40901207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A409010Medicaid
CA00A409010Medicaid