Provider Demographics
NPI:1649777632
Name:ABURAYYAN, KANANA MOHAMMAD
Entity type:Individual
Prefix:
First Name:KANANA
Middle Name:MOHAMMAD
Last Name:ABURAYYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 W COUNTRY CLUB RD STE 105
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-5222
Mailing Address - Country:US
Mailing Address - Phone:575-624-4651
Mailing Address - Fax:575-624-4875
Practice Address - Street 1:350 W COUNTRY CLUB RD STE 105
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-5222
Practice Address - Country:US
Practice Address - Phone:575-624-4651
Practice Address - Fax:575-624-4875
Is Sole Proprietor?:No
Enumeration Date:2018-04-07
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2024-0729207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology