Basic Information
| Provider Information | |||||||||
| NPI: | 1063577138 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WALID S ARNAOUT MD A MEDICAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 77 ROLLING OAKS DR STE 203 | ||||||||
| Address2: | |||||||||
| City: | THOUSAND OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913611019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8053799696 | ||||||||
| FaxNumber: | 8053799695 | ||||||||
| Practice Location | |||||||||
| Address1: | 77 ROLLING OAKS DR STE 203 | ||||||||
| Address2: | |||||||||
| City: | THOUSAND OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8053799696 | ||||||||
| FaxNumber: | 8053799695 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2006 | ||||||||
| LastUpdateDate: | 05/23/2019 | ||||||||
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| AuthorizedOfficialLastName: | ARNAOUT | ||||||||
| AuthorizedOfficialFirstName: | WALID | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8053799696 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 2086S0127X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery | 208600000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 00A53180 | 05 | CA | MEDICAID |