Healthcare Provider Details

I. General information

NPI: 1164478855
Provider Name (Legal Business Name): REHANA S. BAQAI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 E ONTARIO AVE SUITE # 101
CORONA CA
92879-3506
US

IV. Provider business mailing address

18111 BROOKHURST ST SUITE # 6100
FOUNTAIN VALLEY CA
92708-6728
US

V. Phone/Fax

Practice location:
  • Phone: 951-371-2411
  • Fax: 951-284-0177
Mailing address:
  • Phone: 714-698-0300
  • Fax: 714-698-0313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA48182
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA48182
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: