Individual
BADR KHALIL GHUMRAWI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
43 SAN SIMEON, LAGUNA NIGUEL, CA 92677-7951
(949) 495-5161
Mailing address
43 SAN SIMEON, LAGUNA NIGUEL, CA 92677-7951
(949) 495-5161
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
C51860
CA
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
C51860
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000129043
ANTHEM
—
05
—
0231538
—
OH
01
—
100430
KAISER
—
01
—
27174
NATIONWIDE
—
01
—
4132029
AETNA
—
01
—
71479
QUALCHOICE
—
Enumeration date
11/20/2006
Last updated
03/16/2021
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