Provider Demographics
NPI:1407199243
Name:PATHWAY MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:PATHWAY MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:HASSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ALKHOULI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-379-3221
Mailing Address - Street 1:PO BOX 2989
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-1989
Mailing Address - Country:US
Mailing Address - Phone:714-379-3221
Mailing Address - Fax:714-823-4716
Practice Address - Street 1:515 S BEACH BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-1812
Practice Address - Country:US
Practice Address - Phone:714-827-4240
Practice Address - Fax:714-827-5785
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PATHWAY MEDICAL GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-29
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty