Healthcare Provider Details

I. General information

NPI: 1942272075
Provider Name (Legal Business Name): IHAB EDWARD BEBLAWI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 11/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 ALESSANDRO PL SUITE 410
PASADENA CA
91105-3149
US

IV. Provider business mailing address

50 ALESSANDRO PL SUITE 410
PASADENA CA
91105-3149
US

V. Phone/Fax

Practice location:
  • Phone: 626-796-7114
  • Fax: 818-889-0408
Mailing address:
  • Phone: 626-793-7114
  • Fax: 818-889-0408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA48496
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: