Provider Demographics
NPI:1285833699
Name:GIRGIS, SHERIF S (MD)
Entity Type:Individual
Prefix:
First Name:SHERIF
Middle Name:S
Last Name:GIRGIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 LEANNE TER
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-3613
Mailing Address - Country:US
Mailing Address - Phone:951-741-6443
Mailing Address - Fax:
Practice Address - Street 1:1530 LEANNE TER
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-3613
Practice Address - Country:US
Practice Address - Phone:951-741-6443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.026697207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1058891Medicaid
LA1058891Medicaid