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Individual

MIKE HESHMAT GEBRAEL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
22617 US HIGHWAY 18, APPLE VALLEY, CA 92307-4342
(714) 457-9366
Mailing address
13251 STANFORD DR, VICTORVILLE, CA 92392-7247
(714) 457-9366

Taxonomy

Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
TCP0028493P
CA

Other

Enumeration date
08/10/2012
Last updated
08/10/2012
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