Healthcare Provider Details

I. General information

NPI: 1780931709
Provider Name (Legal Business Name): MUNTHER ALQAISI M.D. A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2012
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 BROCKTON AVE 101
RIVERSIDE CA
92501-4090
US

IV. Provider business mailing address

2650 ELM AVE 201
LONG BEACH CA
90806-1651
US

V. Phone/Fax

Practice location:
  • Phone: 562-492-6695
  • Fax: 562-492-6695
Mailing address:
  • Phone: 562-492-6695
  • Fax: 562-988-0389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: MUNTHER ALQAISI
Title or Position: OWNER
Credential: MD
Phone: 562-492-6695