Provider Demographics
NPI:1881649853
Name:IDRISS, ALMOATAZBELLAH MAGDELDIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALMOATAZBELLAH
Middle Name:MAGDELDIN
Last Name:IDRISS
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 1:200 S MANCHESTER AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3219
Mailing Address - Country:US
Mailing Address - Phone:714-456-2986
Mailing Address - Fax:
Practice Address - Street 1:1451 IRVINE BLVD
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3804
Practice Address - Country:US
Practice Address - Phone:714-838-8408
Practice Address - Fax:714-838-0025
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93285207RE0101X
CAC54167207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2730146Medicaid
FLU5345Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID #
FL2730146Medicaid