Healthcare Provider Details

I. General information

NPI: 1184357394
Provider Name (Legal Business Name): ANTOINE SIOUFI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2022
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 JAMBOREE RD STE 1200
NEWPORT BEACH CA
92660-2904
US

IV. Provider business mailing address

7710 MERCY RD STE 202
OMAHA NE
68124-2353
US

V. Phone/Fax

Practice location:
  • Phone: 949-988-7888
  • Fax:
Mailing address:
  • Phone: 402-280-4318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9389
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: