Healthcare Provider Details

I. General information

NPI: 1114027125
Provider Name (Legal Business Name): SYLVIA MARY GUIRGUIS FELOBOUS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8204 LONG BEACH BLVD SUITE B
SOUTH GATE CA
90280-2011
US

IV. Provider business mailing address

8204 LONG BEACH BLVD SUITE B
SOUTH GATE CA
90280-2011
US

V. Phone/Fax

Practice location:
  • Phone: 323-588-3300
  • Fax: 323-588-0855
Mailing address:
  • Phone: 323-588-3300
  • Fax: 323-588-0855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA75000
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: