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General NPI Number Information
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NPI Number | 1467475442
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Entity Type | Individual
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Provider Name | WALEED QAISI MD
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Gender | Male
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 02/22/2023
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Provider Practice Location Address
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Address Line | 2428 SANTA MONICA BLVD
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City | SANTA MONICA
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State | CA
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Zip | 90404-2045
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Country | US
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Telephone | 310-315-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 2701 NW VAUGHN ST STE 425
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City | PORTLAND
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State | OR
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Zip | 97210-5311
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Country | US
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Telephone | 503-227-2400
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Fax | 503-227-0218
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | C168272
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD23292
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License Number State | OR
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