Provider Demographics
NPI:1801044839
Name:GERAYLI, AFROUZ S (MD)
Entity Type:Individual
Prefix:
First Name:AFROUZ
Middle Name:S
Last Name:GERAYLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 PASEO CAMARILLO
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-5900
Mailing Address - Country:US
Mailing Address - Phone:805-484-1033
Mailing Address - Fax:805-482-7213
Practice Address - Street 1:500 PASEO CAMARILLO
Practice Address - Street 2:SUITE 100
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-5900
Practice Address - Country:US
Practice Address - Phone:805-484-1033
Practice Address - Fax:805-482-7213
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2010-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70360207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A703600Medicaid
H49309Medicare UPIN
A70360Medicare PIN