Provider Demographics
NPI:1316955446
Name:AL QURAINI, TALAL (MD)
Entity type:Individual
Prefix:
First Name:TALAL
Middle Name:
Last Name:AL QURAINI
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 1:2525 RIDGEGATE ROW
Mailing Address - Street 2:SUITE 900
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-0930
Mailing Address - Country:US
Mailing Address - Phone:858-361-8004
Mailing Address - Fax:
Practice Address - Street 1:751 MEDICAL CENTER CT
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-6617
Practice Address - Country:US
Practice Address - Phone:619-482-5825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61433207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1316955446Medicaid
CA1316955446Medicaid
CABA802ZMedicare PIN
CAG52575Medicare UPIN