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General NPI Number Information
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NPI Number | 1447301833
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Entity Type | Organization
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Legal Business Name | BAHAA GIRGIS, M.D., INC
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Dates
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Enumeration Date | 01/15/2007
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Last Update Date | 09/24/2014
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Provider Practice Location Address
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Address Line | 9194 MAGNOLIA AVE
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City | RIVERSIDE
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State | CA
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Zip | 92503-3872
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Country | US
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Telephone | 951-352-2421
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Fax |
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Provider Business Mailing Address
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Address Line | 11 WHITECLIFF
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-9236
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Country | US
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Telephone | 951-352-2421
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. BAHAA BOLOUS GIRGIS SR.
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Credential | M.D.
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Telephone | 951-352-2421
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | A64665
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License Number State | CA
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