Provider Demographics
NPI:1861796195
Name:MAHER M SALEEB, M.D., INC
Entity type:Organization
Organization Name:MAHER M SALEEB, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHER
Authorized Official - Middle Name:M
Authorized Official - Last Name:SALEEB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-957-4997
Mailing Address - Street 1:5688 COUSINS PL
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91737-2156
Mailing Address - Country:US
Mailing Address - Phone:909-948-7548
Mailing Address - Fax:
Practice Address - Street 1:20072 SW BIRCH ST
Practice Address - Street 2:STE # 240
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-0794
Practice Address - Country:US
Practice Address - Phone:949-955-1088
Practice Address - Fax:909-380-8604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-30
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54830261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8212417Medicaid
AR755OtherMEDICARE ID - DMH
00A548300OtherMEDICARE ID - TYPE UNSPECIFIED
G54233Medicare UPIN
00A548300OtherMEDICARE ID - TYPE UNSPECIFIED