Healthcare Provider Details

I. General information

NPI: 1821087511
Provider Name (Legal Business Name): EMAD D BISHAY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 12/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3156 VISTA WAY SUITE 405
OCEANSIDE CA
92056-3622
US

IV. Provider business mailing address

2604 EL CAMINO REAL SUITE 392
CARLSBAD CA
92008-1205
US

V. Phone/Fax

Practice location:
  • Phone: 760-439-6581
  • Fax: 760-439-6585
Mailing address:
  • Phone: 760-633-2320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number77193
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: