Provider Demographics
NPI:1750458659
Name:TABEL, GHASAN M (MD)
Entity type:Individual
Prefix:
First Name:GHASAN
Middle Name:M
Last Name:TABEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 W FOOTHILL PKWY STE 105-348
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-8545
Mailing Address - Country:US
Mailing Address - Phone:714-501-3824
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:160 W FOOTHILL PKWY # 105-348
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-8545
Practice Address - Country:US
Practice Address - Phone:951-374-0025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88852207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A888520Medicaid
CA00A888520Medicaid