Provider Demographics
NPI:1982810594
Name:MARAYA ALTUWAIJRI, M.D., A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:MARAYA ALTUWAIJRI, M.D., A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALTUWAIJRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-364-0080
Mailing Address - Street 1:24331 EL TORO RD STE 380
Mailing Address - Street 2:
Mailing Address - City:LAGUNA WOODS
Mailing Address - State:CA
Mailing Address - Zip Code:92637-3104
Mailing Address - Country:US
Mailing Address - Phone:949-364-0080
Mailing Address - Fax:949-364-0088
Practice Address - Street 1:24331 EL TORO RD STE 380
Practice Address - Street 2:
Practice Address - City:LAGUNA WOODS
Practice Address - State:CA
Practice Address - Zip Code:92637-3104
Practice Address - Country:US
Practice Address - Phone:949-364-0080
Practice Address - Fax:949-364-0088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA785022086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
I17301Medicare UPIN