MEDICARE: WAEL ALFY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	63501	CA

General Provider Information

NPI Number	:	1336548536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WAEL ALFY

Provider Business Mailing Address
First Line	:	2555 WINSTON CT
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92408-4138
Country	:	US
Telephone Number	:	402-617-9242
Fax Number	:

Provider Business Practice Location Address
First Line	:	1513 FREMONT BLVD
Second Line	:	SUITE E-2
City	:	SEASIDE
State	:	CA
Zip	:	93955-4319
Country	:	US
Telephone Number	:	831-324-4492
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2014
Last Update Date	:	08/14/2014

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