Provider Demographics
NPI:1093868515
Name:REDA M. GAMAL, M.D., INC.
Entity Type:Organization
Organization Name:REDA M. GAMAL, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-245-0353
Mailing Address - Street 1:1125 E. 17TH ST SUITE W238
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701
Mailing Address - Country:US
Mailing Address - Phone:714-245-0353
Mailing Address - Fax:714-569-0492
Practice Address - Street 1:1125 E. 17TH ST SUITE W238
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701
Practice Address - Country:US
Practice Address - Phone:714-245-0353
Practice Address - Fax:714-569-0492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA478902084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A47890Medicare ID - Type Unspecified
F68056Medicare UPIN