Healthcare Provider Details

I. General information

NPI: 1346622982
Provider Name (Legal Business Name): ABDELRAHMAN MOHAMED SAFWAT ABDELAZIM M.B.B.CH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2015
Last Update Date: 04/30/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 UTAH AVE STE 200
EL SEGUNDO CA
90245-4817
US

IV. Provider business mailing address

2330 UTAH AVE STE 200
EL SEGUNDO CA
90245-4817
US

V. Phone/Fax

Practice location:
  • Phone: 424-290-8004
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberT7405
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: