Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0129X | Vascular Surgeon | C51860 | CA |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | C51860 | CA |
NPI | 1013081322 |
---|---|
Provider Name | Badr Khalil Ghumrawi |
First Address | Laguna Niguel, CA 92677-7951 |
Second Address | Laguna Niguel, CA 92677-7951 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 16/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000129043 | ANTHEM (01) | |
0231538 | (05) | OH |
100430 | KAISER (01) | |
27174 | NATIONWIDE (01) | |
4132029 | AETNA (01) | |
71479 | QUALCHOICE (01) | |
A76208 | (02) |