Healthcare Provider Details

I. General information

NPI: 1831199058
Provider Name (Legal Business Name): ZOHEIR RACHED EL-HAJJAOUI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 10/22/2021
Certification Date: 10/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12550 HESPERIA RD SUITE 100
VICTORVILLE CA
92395-5873
US

IV. Provider business mailing address

17095 MAIN ST
HESPERIA CA
92345-6004
US

V. Phone/Fax

Practice location:
  • Phone: 760-241-6666
  • Fax: 760-951-1609
Mailing address:
  • Phone: 760-241-6666
  • Fax: 760-951-1609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA53356
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: