Healthcare Provider Details

I. General information

NPI: 1154774933
Provider Name (Legal Business Name): IMAN GUIRGIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2016
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3090 BRISTOL ST STE 200
COSTA MESA CA
92626-3061
US

IV. Provider business mailing address

3812 MONTEGO DR
HUNTINGTON BEACH CA
92649-2006
US

V. Phone/Fax

Practice location:
  • Phone: 888-789-9585
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC55832
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: