Healthcare Provider Details

I. General information

NPI: 1265882161
Provider Name (Legal Business Name): WILLIAM J RAHAL MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 06/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 N ROXBURY DR PENTHOUSE SUITE
BEVERLY HILLS CA
90210-4206
US

IV. Provider business mailing address

465 N ROXBURY DR PENTHOUSE SUITE
BEVERLY HILLS CA
90210-4206
US

V. Phone/Fax

Practice location:
  • Phone: 917-426-7874
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA136353
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberA136353
License Number StateCA

VIII. Authorized Official

Name: DR. WILLIAM J RAHAL
Title or Position: SURGEON
Credential: M.D.
Phone: 609-575-7225