Healthcare Provider Details

I. General information

NPI: 1558991596
Provider Name (Legal Business Name): PRECISION RHEUMATOLOGY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2020
Last Update Date: 06/29/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 S EUCLID ST
ANAHEIM CA
92802-3111
US

IV. Provider business mailing address

2500 E BALL RD STE 100
ANAHEIM CA
92806-5062
US

V. Phone/Fax

Practice location:
  • Phone: 714-883-7180
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARYAM GUL
Title or Position: PRESIDENT
Credential:
Phone: 714-883-7180