Provider Demographics
NPI:1497858906
Name:GHARGHOURY, AYAD M (MD)
Entity type:Individual
Prefix:DR
First Name:AYAD
Middle Name:M
Last Name:GHARGHOURY
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 1:58383 29 PALMS HWY
Mailing Address - Street 2:SUITE # 100
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-5805
Mailing Address - Country:US
Mailing Address - Phone:760-228-5864
Mailing Address - Fax:
Practice Address - Street 1:58383 29 PALMS HWY
Practice Address - Street 2:SUITE # 100
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-5805
Practice Address - Country:US
Practice Address - Phone:760-228-5864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50604207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A506042Medicaid
CA00A506042Medicaid
CAF62768Medicare UPIN