Walla Al-Hertani, M.D.

Primary specialty

Clinical Genetics (M.D.) PhysicianTaxonomy code 207SG0201X

License

C196993 Issued in CA

Practice address

1201 W la Veta Ave
Orange, CA 92868-4203

Phone

(714) 509-4873

Fax

(714) 509-4788

NPI assigned

Nov 14, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Children'S Hospital Pediatric Associates, Inc

  • Pediatrics Physician
  • Boston, MA
  • NPI 1457306664
  NPD
• Pediatric Subspecialty Faculty, Inc.

  • Pediatrics Physician
  • Orange, CA
  • NPI 1790850279
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1542153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722038400000",
    "number": "1104395656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 W LA VETA AVE",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928684203",
            "telephone_number": "714-509-4873",
            "fax_number": "714-509-4788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 W LA VETA AVE",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928684203",
            "telephone_number": "714-509-4873",
            "fax_number": "714-509-4788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AL-HERTANI",
        "first_name": "WALLA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-14",
        "last_updated": "2024-07-27",
        "certification_date": "2024-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207SG0201X",
            "taxonomy_group": "",
            "desc": "Medical Genetics, Clinical Genetics (M.D.)",
            "state": "CA",
            "license": "C196993",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Omaima Khalid Al Qaraghuli
• Malk Nihad Al Rubaye
• Saif Al Yaseen, M.D.
• Amir Al-Akhras
• Talal Al-Assil
• Sana Al-Jundi, M.D.
• Yadani Al-Saleh, M.D.
• Heba Marzouk Al-Shoubaki, PA-C
• Alaa Abousaif MD a Medical Corp
• Boaz Alailima

• Clinical Genetics (M.D.) Physician in Orange, CA
• Providers in Orange, CA by specialty
• Clinical Genetics (M.D.) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.