Provider Demographics
NPI:1366636045
Name:AFSHIN GERAYLI MD A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:AFSHIN GERAYLI MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GERAYLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-297-3838
Mailing Address - Street 1:35 CREEK RD
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-4724
Mailing Address - Country:US
Mailing Address - Phone:949-297-3838
Mailing Address - Fax:949-297-3839
Practice Address - Street 1:35 CREEK RD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4724
Practice Address - Country:US
Practice Address - Phone:949-297-3838
Practice Address - Fax:949-297-3839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG80098174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTAX ID
CAW21488Medicare PIN