Provider Demographics
NPI:1447215660
Name:SAWIRES, SAMEH G (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMEH
Middle Name:G
Last Name:SAWIRES
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 893430
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92589-3430
Mailing Address - Country:US
Mailing Address - Phone:951-676-7175
Mailing Address - Fax:951-736-1572
Practice Address - Street 1:910 WINSTON WAY
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-7459
Practice Address - Country:US
Practice Address - Phone:951-676-7175
Practice Address - Fax:951-736-1572
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48987207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A489870Medicaid
CAE41106Medicare UPIN