Healthcare Provider Details

I. General information

NPI: 1679604235
Provider Name (Legal Business Name): WAGIH ABDELMALAK ELSEWAFY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23501 CINEMA DR STE 200
SANTA CLARITA CA
91355-5430
US

IV. Provider business mailing address

23501 CINEMA DRIVE SUIT 200
SANTA CLARITA CA
91355-5622
US

V. Phone/Fax

Practice location:
  • Phone: 661-288-4800
  • Fax: 661-254-3094
Mailing address:
  • Phone: 661-288-4800
  • Fax: 661-254-3094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA056248
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA56248
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: