Healthcare Provider Details

I. General information

NPI: 1619095841
Provider Name (Legal Business Name): BILAL RAFIC RAYES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 06/23/2021
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 SAN BERNARDINO RD
UPLAND CA
91786-4920
US

IV. Provider business mailing address

8816 FOOTHILL BLVD STE 103
RANCHO CUCAMONGA CA
91730-7199
US

V. Phone/Fax

Practice location:
  • Phone: 562-236-2999
  • Fax: 888-228-3419
Mailing address:
  • Phone: 909-579-6753
  • Fax: 909-694-1045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA104429
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberA104429
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License NumberA104429
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number37463
License Number StateAZ
# 5
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA104429
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: