Provider Demographics
NPI:1326255084
Name:MOUKARZEL MEDICAL CORP
Entity Type:Organization
Organization Name:MOUKARZEL MEDICAL CORP
Other - Org Name:FEMINA CAREO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIAS
Authorized Official - Middle Name:N
Authorized Official - Last Name:MOUKARZEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-352-4103
Mailing Address - Street 1:2109 ROSS AVE
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-3685
Mailing Address - Country:US
Mailing Address - Phone:760-352-4103
Mailing Address - Fax:760-352-6221
Practice Address - Street 1:2109 ROSS AVE
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-3685
Practice Address - Country:US
Practice Address - Phone:760-352-4103
Practice Address - Fax:760-352-6221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50303305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C503030Medicaid
CA00C503030Medicaid
CAF76436Medicare UPIN