Provider Demographics
NPI:1710910047
Name:RAYHANABAD, SIMON B (MD)
Entity Type:Individual
Prefix:
First Name:SIMON
Middle Name:B
Last Name:RAYHANABAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:3791 KATELLA AVE
Mailing Address - Street 2:#201
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3105
Mailing Address - Country:US
Mailing Address - Phone:562-596-6736
Mailing Address - Fax:562-596-5387
Practice Address - Street 1:3791 KATELLA AVE
Practice Address - Street 2:#201
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3105
Practice Address - Country:US
Practice Address - Phone:562-596-6736
Practice Address - Fax:562-596-5387
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA36844208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A368440Medicaid
CAWA36844Medicare ID - Type Unspecified
CA00A368440Medicaid