MEDICARE: MR. AMIN ELRAYAH ELHAG

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	172A00000X	Driver	900928659	AZ

General Provider Information

NPI Number	:	1467898973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. AMIN ELRAYAH ELHAG

Provider Business Mailing Address
First Line	:	630 N FRESNO ST
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85225-3720
Country	:	US
Telephone Number	:	480-326-2165
Fax Number	:

Provider Business Practice Location Address
First Line	:	630 N FRESNO ST
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85225-3720
Country	:	US
Telephone Number	:	480-326-2165
Fax Number	:

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

Provider Enumeration Date	:	05/12/2013
Last Update Date	:	05/12/2013

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