Healthcare Provider Details

I. General information

NPI: 1023277753
Provider Name (Legal Business Name): DR. ESSAM HASSAN ELSHEWI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2008
Last Update Date: 08/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2271 E PALMDALE BLVD # E1
PALMDALE CA
93550-1340
US

IV. Provider business mailing address

2271 E PALMDALE BLVD # E1
PALMDALE CA
93550-1340
US

V. Phone/Fax

Practice location:
  • Phone: 661-538-9922
  • Fax: 661-538-9199
Mailing address:
  • Phone: 661-538-9922
  • Fax: 661-538-9199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA104045
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: