Healthcare Provider Details

I. General information

NPI: 1316955446
Provider Name (Legal Business Name): TALAL AL QURAINI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 11/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 MEDICAL CENTER CT
CHULA VISTA CA
91911-6617
US

IV. Provider business mailing address

2525 RIDGEGATE ROW SUITE 900
LA JOLLA CA
92037-0930
US

V. Phone/Fax

Practice location:
  • Phone: 619-482-5825
  • Fax:
Mailing address:
  • Phone: 858-361-8004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberA61433
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: