Provider Demographics
NPI:1316925761
Name:ALTUWAIJRI, MARAYA A (MD)
Entity type:Individual
Prefix:
First Name:MARAYA
Middle Name:A
Last Name:ALTUWAIJRI
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 1:24331 EL TORO RD STE 380
Mailing Address - Street 2:
Mailing Address - City:LAGUNA WOODS
Mailing Address - State:CA
Mailing Address - Zip Code:92637-3104
Mailing Address - Country:US
Mailing Address - Phone:949-364-0080
Mailing Address - Fax:949-364-0088
Practice Address - Street 1:24331 EL TORO RD STE 380
Practice Address - Street 2:
Practice Address - City:LAGUNA WOODS
Practice Address - State:CA
Practice Address - Zip Code:92637-3104
Practice Address - Country:US
Practice Address - Phone:949-364-0080
Practice Address - Fax:949-364-0088
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA785022086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN687673100Medicaid
MN687673100Medicaid
DH073AMedicare UPIN
MN770000054Medicare ID - Type Unspecified