Provider Demographics
NPI:1144557539
Name:I HENAWI MD INC
Entity type:Organization
Organization Name:I HENAWI MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:I
Authorized Official - Middle Name:
Authorized Official - Last Name:HENAWI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-765-5000
Mailing Address - Street 1:4020 W FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92545-5279
Mailing Address - Country:US
Mailing Address - Phone:951-765-5000
Mailing Address - Fax:951-658-0237
Practice Address - Street 1:4020 W FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92545-5279
Practice Address - Country:US
Practice Address - Phone:951-765-5000
Practice Address - Fax:951-658-0237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-06
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62143208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1144557539Medicaid
CACS602AOtherPROVIDER NUMBER
CA1144557539Medicaid