Provider Demographics
NPI:1861674376
Name:A. RAY MABAQUIAO M.D. APMC
Entity Type:Organization
Organization Name:A. RAY MABAQUIAO M.D. APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:MABAQUIAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-644-0488
Mailing Address - Street 1:8851 CENTER DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3017
Mailing Address - Country:US
Mailing Address - Phone:760-353-0488
Mailing Address - Fax:760-353-2796
Practice Address - Street 1:1745 S IMPERIAL AVE STE C
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-4252
Practice Address - Country:US
Practice Address - Phone:760-353-0488
Practice Address - Fax:760-353-2796
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:A. RAY MABAQUIAO M.D. APMC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-27
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19519AMedicare PIN