Provider Demographics
NPI:1245410950
Name:MOHAMED EL-GABALAWY, MD INC
Entity Type:Organization
Organization Name:MOHAMED EL-GABALAWY, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:EL-GABALAWY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-799-5520
Mailing Address - Street 1:1111 S ARROYO PKWY
Mailing Address - Street 2:SUITE 405
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3254
Mailing Address - Country:US
Mailing Address - Phone:626-799-5520
Mailing Address - Fax:626-799-5570
Practice Address - Street 1:1111 S ARROYO PKWY
Practice Address - Street 2:SUITE 405
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3254
Practice Address - Country:US
Practice Address - Phone:626-799-5520
Practice Address - Fax:626-799-5570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC503052084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE54298Medicare UPIN