Provider Demographics
NPI:1558434464
Name:BEBAWY, NAGY PHILIPS (MD)
Entity Type:Individual
Prefix:DR
First Name:NAGY
Middle Name:PHILIPS
Last Name:BEBAWY
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 1:1307 W. 6TH STREET
Mailing Address - Street 2:SUITE 113
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882
Mailing Address - Country:US
Mailing Address - Phone:951-278-8910
Mailing Address - Fax:951-278-9895
Practice Address - Street 1:1307 W. 6TH STREET
Practice Address - Street 2:SUITE 113
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882
Practice Address - Country:US
Practice Address - Phone:951-278-8910
Practice Address - Fax:951-278-9895
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44080171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA44080OtherCA LICENSE NUMBER