Healthcare Provider Details

I. General information

NPI: 1578341608
Provider Name (Legal Business Name): PACIFIC PROFESSIONAL SURGICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4234 RIVERWALK PKWY STE 230
RIVERSIDE CA
92505-3312
US

IV. Provider business mailing address

4 HUGHES STE 100
IRVINE CA
92618-2043
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: AHMED EL-BERSHAWI
Title or Position: PRESIDENT
Credential: MD
Phone: 949-874-9071