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General NPI Number Information
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NPI Number | 1578519054
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Entity Type | Organization
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Legal Business Name | PATHWAY MEDICAL GROUP, INC
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 05/06/2008
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Provider Practice Location Address
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Address Line | 11100 WARNER AVE #120
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-7506
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Country | US
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Telephone | 714-556-8480
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Fax | 714-534-0818
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Provider Business Mailing Address
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Address Line | PO BOX 2989
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City | SEAL BEACH
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State | CA
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Zip | 90740-1989
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Country | US
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Telephone | 714-379-3221
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Fax | 714-379-3211
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Authorized Official
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Title or Position | C.E.O.
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Name | DR. HASSAN M. ALKHOULI
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Credential | M.D.
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Telephone | 714-379-3221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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