Provider Demographics
NPI:1447301833
Name:BAHAA GIRGIS, M.D., INC
Entity type:Organization
Organization Name:BAHAA GIRGIS, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BAHAA
Authorized Official - Middle Name:BOLOUS
Authorized Official - Last Name:GIRGIS
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:951-352-2421
Mailing Address - Street 1:11 WHITECLIFF
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-9236
Mailing Address - Country:US
Mailing Address - Phone:951-352-2421
Mailing Address - Fax:
Practice Address - Street 1:9194 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3872
Practice Address - Country:US
Practice Address - Phone:951-352-2421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64665261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A646650Medicare PIN