Provider Demographics
NPI:1710398003
Name:MOHAMED W ELNACHEF MD
Entity Type:Organization
Organization Name:MOHAMED W ELNACHEF MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:W
Authorized Official - Last Name:EL-NACHEF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-414-9594
Mailing Address - Street 1:PO BOX 12083
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92859-8083
Mailing Address - Country:US
Mailing Address - Phone:714-414-9594
Mailing Address - Fax:
Practice Address - Street 1:1001 N TUSTIN AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3502
Practice Address - Country:US
Practice Address - Phone:714-414-9594
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50556207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty