Healthcare Provider Details

I. General information

NPI: 1134381536
Provider Name (Legal Business Name): ELIE M HOBEIKA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 10/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 E WASHINGTON BLVD STE 202
CRESCENT CITY CA
95531-8397
US

IV. Provider business mailing address

780 E WASHINGTON BLVD STE 202
CRESCENT CITY CA
95531-8397
US

V. Phone/Fax

Practice location:
  • Phone: 707-464-6715
  • Fax:
Mailing address:
  • Phone: 707-464-6715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA108245
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: