Provider Demographics
NPI:1609143775
Name:JESSICA A. RAYHANABAD, M.D. INC
Entity Type:Organization
Organization Name:JESSICA A. RAYHANABAD, M.D. INC
Other - Org Name:CENTER FOR ADVANCED BREAST CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:A
Authorized Official - Last Name:RAYHANABAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-206-1312
Mailing Address - Street 1:12340 SEAL BEACH BLVD
Mailing Address - Street 2:SUITE B 421
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-2792
Mailing Address - Country:US
Mailing Address - Phone:562-799-3250
Mailing Address - Fax:562-799-3259
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-17
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty