Healthcare Provider Details

I. General information

NPI: 1386813103
Provider Name (Legal Business Name): EL-BERSHAWI MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4234 RIVERWALK PKWY SUITE 230
RIVERSIDE CA
92505-8510
US

IV. Provider business mailing address

4234 RIVERWALK PKWY SUITE 230
RIVERSIDE CA
92505-8510
US

V. Phone/Fax

Practice location:
  • Phone: 951-781-3672
  • Fax: 951-781-0365
Mailing address:
  • Phone: 951-781-3672
  • Fax: 951-781-0365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA90658
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA90658
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberA90658
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA90658
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA90658
License Number StateCA

VIII. Authorized Official

Name: DR. AHMED EL-BERSHAWI
Title or Position: OWNER/MEDICAL DIRECTOR
Credential: M.D.
Phone: 951-781-3672