Healthcare Provider Details

I. General information

NPI: 1912617408
Provider Name (Legal Business Name): ENGY BEBAWAY PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2022
Last Update Date: 11/25/2022
Certification Date: 11/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

638 CAMINO DE LOS MARES
SAN CLEMENTE CA
92673-2848
US

IV. Provider business mailing address

638 CAMINO DE LOS MARES
SAN CLEMENTE CA
92673-2848
US

V. Phone/Fax

Practice location:
  • Phone: 714-580-4125
  • Fax:
Mailing address:
  • Phone: 714-580-4125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number87305
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: