Provider Demographics
NPI:1407967631
Name:EL-GABALAWY, MOHAMED (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:
Last Name:EL-GABALAWY
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:PO BOX 50611
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91115-0611
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
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC503052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C503050Medicaid
CAW17285Medicare PIN
CAWC50305BMedicare PIN
CA00C503050Medicaid