Provider Demographics
NPI:1295828259
Name:AFROUZ GERAYLI MD INC
Entity type:Organization
Organization Name:AFROUZ GERAYLI MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AFOUZ
Authorized Official - Middle Name:S
Authorized Official - Last Name:GERAYLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-484-1033
Mailing Address - Street 1:500 PASEO CAMARILLO
Mailing Address - Street 2:#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:#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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A703600Medicaid
CAA70360Medicare ID - Type Unspecified
H49309Medicare UPIN