Healthcare Provider Details

I. General information

NPI: 1497873608
Provider Name (Legal Business Name): ADEL A ELDAHMY M.D., M.B.A
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 08/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 E PACIFIC COAST HWY SUITE 120
LONG BEACH CA
90804-3275
US

IV. Provider business mailing address

4500 E. PACIFIC COAST HWY SUITE 120
LONG BEACH CA
90804-3275
US

V. Phone/Fax

Practice location:
  • Phone: 562-597-7575
  • Fax: 562-498-8309
Mailing address:
  • Phone: 562-597-7575
  • Fax: 562-498-8309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA37156
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: