MEDICARE: DR. WADI ROUEL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	C55979	CA
2	207Q00000X	Family Medicine Physician	ME92300	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740254713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WADI ROUEL M.D.

Provider Business Mailing Address
First Line	:	4060 FAIRMOUNT AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92105-1608
Country	:	US
Telephone Number	:	619-584-1612
Fax Number	:	619-281-6738

Provider Business Practice Location Address
First Line	:	4060 FAIRMOUNT AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92105-1608
Country	:	US
Telephone Number	:	619-584-1612
Fax Number	:	619-281-6738

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	09/21/2018

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