Healthcare Provider Details

I. General information

NPI: 1932304813
Provider Name (Legal Business Name): ALAIN A WAKED M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 BROCKTON AVE STE 203
RIVERSIDE CA
92501-4006
US

IV. Provider business mailing address

4500 BROCKTON AVE STE 203
RIVERSIDE CA
92501-4006
US

V. Phone/Fax

Practice location:
  • Phone: 951-686-3600
  • Fax: 951-686-1162
Mailing address:
  • Phone: 951-686-3600
  • Fax: 951-686-1162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA143528
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberA143528
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: