Healthcare Provider Details

I. General information

NPI: 1952350829
Provider Name (Legal Business Name): LAMIA GABAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 N TUSTIN AVE STE 104
SANTA ANA CA
92705-3606
US

IV. Provider business mailing address

720 N TUSTIN AVE STE 104
SANTA ANA CA
92705-3606
US

V. Phone/Fax

Practice location:
  • Phone: 949-825-7650
  • Fax: 949-825-7648
Mailing address:
  • Phone: 949-825-7659
  • Fax: 949-825-7648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2088F0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Urology) Physician
License NumberA61924
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberA61924
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: