Provider Demographics
NPI:1164478855
Name:BAQAI, REHANA S (MD)
Entity type:Individual
Prefix:
First Name:REHANA
Middle Name:S
Last Name:BAQAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18111 BROOKHURST ST
Mailing Address - Street 2:SUITE # 6100
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-6728
Mailing Address - Country:US
Mailing Address - Phone:714-698-0300
Mailing Address - Fax:714-698-0313
Practice Address - Street 1:260 E ONTARIO AVE
Practice Address - Street 2:SUITE # 101
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3506
Practice Address - Country:US
Practice Address - Phone:951-371-2411
Practice Address - Fax:951-284-0177
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48182174400000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ64478ZOtherBLUE SHIELD
ZZZ05040ZOtherBLUE SHEILD
CAGR0093942Medicaid
ZZZ05039ZOtherBLUE SHIELD
CAGR0093941Medicaid
CAGR0093940Medicaid
CAGR0093942Medicaid
ZZZ23584ZMedicare PIN
ZZZ03044ZMedicare PIN