Provider Demographics
NPI:1497873608
Name:ELDAHMY, ADEL A (MD, MBA)
Entity Type:Individual
Prefix:DR
First Name:ADEL
Middle Name:A
Last Name:ELDAHMY
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 E. PACIFIC COAST HWY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-3275
Mailing Address - Country:US
Mailing Address - Phone:562-597-7575
Mailing Address - Fax:562-498-8309
Practice Address - Street 1:4500 E PACIFIC COAST HWY
Practice Address - Street 2:SUITE 120
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-3275
Practice Address - Country:US
Practice Address - Phone:562-597-7575
Practice Address - Fax:562-498-8309
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37156101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA37156CMedicare PIN