Provider Demographics
NPI:1407800188
Name:MICHAEL, MANAR MARGERGIS (PA)
Entity Type:Individual
Prefix:MRS
First Name:MANAR
Middle Name:MARGERGIS
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:801 S CHEVY CHASE DR
Mailing Address - Street 2:#20
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-4431
Mailing Address - Country:US
Mailing Address - Phone:818-265-2237
Mailing Address - Fax:818-265-2228
Practice Address - Street 1:12157 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-3204
Practice Address - Country:US
Practice Address - Phone:818-755-8000
Practice Address - Fax:818-755-8006
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA17555363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant