Provider Demographics
NPI:1346566288
Name:SHERIF EL-ASYOUTY MD A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:SHERIF EL-ASYOUTY MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MGR
Authorized Official - Prefix:MISS
Authorized Official - First Name:WILMA
Authorized Official - Middle Name:
Authorized Official - Last Name:CALDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-246-9585
Mailing Address - Street 1:PO BOX 30252
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93130-0252
Mailing Address - Country:US
Mailing Address - Phone:805-884-4989
Mailing Address - Fax:805-882-2220
Practice Address - Street 1:3 W CARRILLO ST
Practice Address - Street 2:SUITE 217
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-3283
Practice Address - Country:US
Practice Address - Phone:805-884-4989
Practice Address - Fax:805-882-2220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-16
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82909103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H05496Medicare UPIN