Healthcare Provider Details

I. General information

NPI: 1437334331
Provider Name (Legal Business Name): EMILE G. SHENOUDA MD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15340 DEVONSHIRE ST SUITE 8
MISSION HILLS CA
91345-2759
US

IV. Provider business mailing address

10132 CALIFORNIA AVE
SOUTH GATE CA
90280-6008
US

V. Phone/Fax

Practice location:
  • Phone: 818-894-9411
  • Fax: 818-894-7611
Mailing address:
  • Phone: 818-894-9411
  • Fax: 818-894-7611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. EMILE GEORGE SHENOUDA
Title or Position: PRESIDENT
Credential: MD
Phone: 818-894-9411