Healthcare Provider Details

I. General information

NPI: 1821296591
Provider Name (Legal Business Name): ANAS KAWAYEH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2007
Last Update Date: 01/06/2020
Certification Date: 01/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 N RIVERSIDE AVE STE A
RIALTO CA
92377-4696
US

IV. Provider business mailing address

375 TERRACINA BLVD
REDLANDS CA
92373-3801
US

V. Phone/Fax

Practice location:
  • Phone: 909-883-2999
  • Fax:
Mailing address:
  • Phone: 909-883-2394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA109588
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: