Healthcare Provider Details

I. General information

NPI: 1215051974
Provider Name (Legal Business Name): NORA HANNA BEBAWI MSPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2621 S BRISTOL ST STE 105
SANTA ANA CA
92704
US

IV. Provider business mailing address

22191 WAYSIDE
MISSION VIEJO CA
92692-4514
US

V. Phone/Fax

Practice location:
  • Phone: 714-617-4833
  • Fax: 951-787-4962
Mailing address:
  • Phone: 949-235-3031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA18542
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: