Healthcare Provider Details

I. General information

NPI: 1205912847
Provider Name (Legal Business Name): ELIAS N MOUKARZEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 WEST ROSS AVE
EL CENTRO CA
92243-3685
US

IV. Provider business mailing address

1296 WESTWIND DR
EL CENTRO CA
92243-4368
US

V. Phone/Fax

Practice location:
  • Phone: 760-352-4103
  • Fax: 760-545-0258
Mailing address:
  • Phone: 760-337-2928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberC50303
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: