MEDICARE: DR. MAGDI H ELBASSIR M.D.,

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	A86654	CA

General Provider Information

NPI Number	:	1194835330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAGDI H ELBASSIR M.D.,

Provider Business Mailing Address
First Line	:	3161 GLENDALE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-1805
Country	:	US
Telephone Number	:	323-662-0365
Fax Number	:	323-662-0368

Provider Business Practice Location Address
First Line	:	3161 GLENDALE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-1805
Country	:	US
Telephone Number	:	323-662-0365
Fax Number	:	323-662-0368

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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