=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245410950
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOHAMED EL-GABALAWY, MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2007
-----------------------------------------------------
Last Update Date | 11/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1111 S ARROYO PKWY SUITE 405
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91105-3254
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-799-5520
-----------------------------------------------------
Fax | 626-799-5570
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1111 S ARROYO PKWY SUITE 405
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91105-3254
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-799-5520
-----------------------------------------------------
Fax | 626-799-5570
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MOHAMED EL-GABALAWY
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 626-799-5520
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084A0401X
-----------------------------------------------------
Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
-----------------------------------------------------
License Number | C50305
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------