MEDICARE: MILK WISE MEDICAL, A PROFESSIONAL CORPORATION

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1891652103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILK WISE MEDICAL, A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	1848 COMMERCIAL ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92113-1037
Country	:	US
Telephone Number	:	818-216-2319
Fax Number	:

Provider Business Practice Location Address
First Line	:	1848 COMMERCIAL ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92113-1037
Country	:	US
Telephone Number	:	858-204-7349
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. RAJY ABULHOSN
Credential	:	MD
Telephone Number	:	858-204-7349

Provider Enumeration Date	:	01/07/2026
Last Update Date	:	03/24/2026

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