Healthcare Provider Details

I. General information

NPI: 1497776355
Provider Name (Legal Business Name): AMGAD R ELSIBAI MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 06/07/2022
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16055 VENTURA BLVD STE 1000
ENCINO CA
91436-2611
US

IV. Provider business mailing address

PO BOX 5486
ORANGE CA
92863-5486
US

V. Phone/Fax

Practice location:
  • Phone: 310-621-1332
  • Fax:
Mailing address:
  • Phone: 818-550-0900
  • Fax: 818-550-0900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA52784
License Number StateCA

VIII. Authorized Official

Name: AMGAD R ELSIBAI
Title or Position: OWNER PRES
Credential: MD
Phone: 310-621-1332