Healthcare Provider Details

I. General information

NPI: 1720009855
Provider Name (Legal Business Name): HAZIM ELMELIGY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 MEDICAL CENTER DR
WEST HILLS CA
91307-1902
US

IV. Provider business mailing address

PO BOX 18198
ENCINO CA
91416-8198
US

V. Phone/Fax

Practice location:
  • Phone: 818-996-0300
  • Fax: 818-992-0306
Mailing address:
  • Phone: 818-996-0300
  • Fax: 818-992-0306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberA44235
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: