Healthcare Provider Details

I. General information

NPI: 1578519054
Provider Name (Legal Business Name): PATHWAY MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 WARNER AVE #120
FOUNTAIN VALLEY CA
92708-7506
US

IV. Provider business mailing address

PO BOX 2989
SEAL BEACH CA
90740-1989
US

V. Phone/Fax

Practice location:
  • Phone: 714-556-8480
  • Fax: 714-534-0818
Mailing address:
  • Phone: 714-379-3221
  • Fax: 714-379-3211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. HASSAN M. ALKHOULI
Title or Position: C.E.O.
Credential: M.D.
Phone: 714-379-3221