Healthcare Provider Details

I. General information

NPI: 1073755476
Provider Name (Legal Business Name): ROBBY T AYOUB MD PROF MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2009
Last Update Date: 08/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8201 NEWMAN AVE SUITE 101
HUNTINGTON BEACH CA
92647-7020
US

IV. Provider business mailing address

17870 NEWHOPE ST SUITE 104-546
FOUNTAIN VALLEY CA
92708-5439
US

V. Phone/Fax

Practice location:
  • Phone: 714-847-6900
  • Fax: 714-847-3900
Mailing address:
  • Phone: 714-847-6900
  • Fax: 714-847-3900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA102841
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBBY T AYOUB
Title or Position: PRESIDENT
Credential: MD
Phone: 714-432-1800