Healthcare Provider Details

I. General information

NPI: 1861468415
Provider Name (Legal Business Name): WAEL A HARB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 AVOCADO AVE STE 301
NEWPORT BEACH CA
92660-7704
US

IV. Provider business mailing address

1441 AVOCADO AVE STE 301
NEWPORT BEACH CA
92660-7704
US

V. Phone/Fax

Practice location:
  • Phone: 949-272-2095
  • Fax: 949-272-2096
Mailing address:
  • Phone: 949-272-2095
  • Fax: 949-272-2096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01044990A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number01044990A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number4301116641
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number01044990A
License Number StateIN
# 5
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number4301116641
License Number StateMI
# 6
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberC172708
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: