Basic Information
| Provider Information | |||||||||
| NPI: | 1255990735 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AL GHALAYINI | ||||||||
| FirstName: | RAYA | ||||||||
| MiddleName: | MAZEN FATHI | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 STANTON L YOUNG BLVD # 1200 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731045018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052718592 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1122 NE 13TH ST # ORB1200 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731171039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052718558 | ||||||||
| FaxNumber: | 4052713887 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2019 | ||||||||
| LastUpdateDate: | 06/08/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 64121 | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RH0002X | 39581 | OK | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine |
No ID Information.