Basic Information
| Provider Information | |||||||||
| NPI: | 1861796195 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MAHER M SALEEB, M.D., INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5688 COUSINS PL | ||||||||
| Address2: | |||||||||
| City: | RANCHO CUCAMONGA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917372156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099487548 | ||||||||
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| Practice Location | |||||||||
| Address1: | 20072 SW BIRCH ST | ||||||||
| Address2: | STE # 240 | ||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926600794 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9499551088 | ||||||||
| FaxNumber: | 9093808604 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/30/2010 | ||||||||
| LastUpdateDate: | 12/30/2010 | ||||||||
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| AuthorizedOfficialLastName: | SALEEB | ||||||||
| AuthorizedOfficialFirstName: | MAHER | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9099574997 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0850X | A54830 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 8212417 | 05 | WA | MEDICAID | AR755 | 01 | MEDICARE ID - DMH | OTHER | 00A548300 | 01 | MEDICARE ID - TYPE UNSPECIFIED | OTHER |