Provider Demographics
NPI:1588680250
Name:ELIAS AYOUB MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ELIAS AYOUB MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIALIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIAS
Authorized Official - Middle Name:I
Authorized Official - Last Name:AYOUB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-862-5160
Mailing Address - Street 1:11480 BROOKSHIRE AVE
Mailing Address - Street 2:303
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-5018
Mailing Address - Country:US
Mailing Address - Phone:562-862-5160
Mailing Address - Fax:562-923-8205
Practice Address - Street 1:11480 BROOKSHIRE AVE
Practice Address - Street 2:303
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-5018
Practice Address - Country:US
Practice Address - Phone:562-862-5160
Practice Address - Fax:562-923-8205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG39256207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G3925618Medicaid
CA00G3925606Medicaid
CAW5609Medicare PIN