Provider Demographics
NPI:1568597250
Name:OSAMAH A EL-ATTAR MD INC
Entity Type:Organization
Organization Name:OSAMAH A EL-ATTAR MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OSAMAH
Authorized Official - Middle Name:AMIN
Authorized Official - Last Name:EL-ATTAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-666-2726
Mailing Address - Street 1:PO BOX 800817
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91380-0817
Mailing Address - Country:US
Mailing Address - Phone:661-430-0935
Mailing Address - Fax:866-431-1210
Practice Address - Street 1:1234 N VERMONT AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-1704
Practice Address - Country:US
Practice Address - Phone:323-666-2726
Practice Address - Fax:323-666-9056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26314207R00000X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A263141Medicaid
CA00A263140Medicaid
CAA26314Medicare ID - Type UnspecifiedPRES. MCARE ID#
CAHA26314Medicare ID - Type UnspecifiedPRES. MCARE PROVIDER ID#
CA00A263141Medicaid