=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982810594
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARAYA ALTUWAIJRI, M.D., A MEDICAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2007
-----------------------------------------------------
Last Update Date | 01/30/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24331 EL TORO RD STE 380
-----------------------------------------------------
City | LAGUNA WOODS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92637-3104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-364-0080
-----------------------------------------------------
Fax | 949-364-0088
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24331 EL TORO RD STE 380
-----------------------------------------------------
City | LAGUNA WOODS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92637-3104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-364-0080
-----------------------------------------------------
Fax | 949-364-0088
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, CEO
-----------------------------------------------------
Name | DR. MARAYA ALTUWAIJRI
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 949-364-0080
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2086S0129X
-----------------------------------------------------
Taxonomy Name | Vascular Surgery Physician
-----------------------------------------------------
License Number | A78502
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------