Provider Demographics
NPI:1023196649
Name:ELKEEB, LAILA M (MD)
Entity type:Individual
Prefix:
First Name:LAILA
Middle Name:M
Last Name:ELKEEB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20301 SW BIRCH ST
Mailing Address - Street 2:100
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-1754
Mailing Address - Country:US
Mailing Address - Phone:949-251-1502
Mailing Address - Fax:949-251-1522
Practice Address - Street 1:20301 SW BIRCH ST
Practice Address - Street 2:100
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1754
Practice Address - Country:US
Practice Address - Phone:949-251-1502
Practice Address - Fax:949-251-1522
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2017-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85384207ND0900X, 208M00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A853840Medicaid
I07525Medicare UPIN