Healthcare Provider Details

I. General information

NPI: 1730529694
Provider Name (Legal Business Name): LAITH TAWFEEQ ALRESHAID MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 08/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S FREMONT AVE BLDG A9 OFFICE OF REVENUE CYCLE MANAGEMENT PROVIDER ENROLLMEN
ALHAMBRA CA
91803-8800
US

IV. Provider business mailing address

4499 VIA MARISOL APT 139
LOS ANGELES CA
90042-5147
US

V. Phone/Fax

Practice location:
  • Phone: 626-457-5848
  • Fax: 626-457-4125
Mailing address:
  • Phone: 626-437-1991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301103709
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA144334
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: