Healthcare Provider Details

I. General information

NPI: 1295874022
Provider Name (Legal Business Name): EDMOND GIDON SARRAF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 04/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 CARRILLO DR STE 210
LOS ANGELES CA
90048
US

IV. Provider business mailing address

PO BOX 846
BEVERLY HILLS CA
90213
US

V. Phone/Fax

Practice location:
  • Phone: 310-888-7778
  • Fax: 310-888-7732
Mailing address:
  • Phone: 310-888-7778
  • Fax: 310-888-7732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA87551
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberA87551
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: