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General NPI Number Information
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NPI Number | 1609143775
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Entity Type | Organization
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Legal Business Name | JESSICA A. RAYHANABAD, M.D. INC
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Dates
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Enumeration Date | 11/17/2011
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Last Update Date | 09/29/2023
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Provider Practice Location Address
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Address Line | 3791 KATELLA AVE STE 201
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-2016
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Country | US
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Telephone | 562-206-1312
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Fax | 562-206-1314
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Provider Business Mailing Address
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Address Line | 12340 SEAL BEACH BLVD SUITE B 421
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City | SEAL BEACH
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State | CA
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Zip | 90740-2792
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Country | US
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Telephone | 562-799-3250
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Fax | 562-799-3259
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JESSICA A RAYHANABAD
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Credential | MD
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Telephone | 562-206-1312
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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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 | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number |
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License Number State |
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