Healthcare Provider Details

I. General information

NPI: 1730251356
Provider Name (Legal Business Name): SOHA DARWISH IDRISS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 E CESAR E CHAVEZ AVE WMMC-NICU
LOS ANGELES CA
90033-2414
US

IV. Provider business mailing address

909 BAY TREE RD
LA CANADA FLINTRIDGE CA
91011-1816
US

V. Phone/Fax

Practice location:
  • Phone: 323-268-5000
  • Fax:
Mailing address:
  • Phone: 818-952-2967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberA052614
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: