Healthcare Provider Details

I. General information

NPI: 1992149843
Provider Name (Legal Business Name): TARIQ IYAD HILAL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2013
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3771 KATELLA AVE STE 107
LOS ALAMITOS CA
90720-3111
US

IV. Provider business mailing address

PO BOX 11769
WESTMINSTER CA
92685-1769
US

V. Phone/Fax

Practice location:
  • Phone: 562-534-2606
  • Fax: 562-534-2604
Mailing address:
  • Phone: 562-534-2606
  • Fax: 562-534-2604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number20A15622
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number20A15622
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number20A15622
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: