Provider Demographics
NPI:1184745051
Name:MOURANI & TARAKJI MEDICAL
Entity type:Organization
Organization Name:MOURANI & TARAKJI MEDICAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOURANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-359-3330
Mailing Address - Street 1:488 E SANTA CLARA ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-7229
Mailing Address - Country:US
Mailing Address - Phone:626-359-3330
Mailing Address - Fax:626-359-3339
Practice Address - Street 1:488 E SANTA CLARA ST
Practice Address - Street 2:SUITE 103
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-7229
Practice Address - Country:US
Practice Address - Phone:626-359-3330
Practice Address - Fax:626-359-3339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0090111Medicaid
CAW14683AMedicare PIN