Provider Demographics
NPI:1134172844
Name:SAWIRIS, SAMIR A (MD)
Entity type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:A
Last Name:SAWIRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 VERDUGO BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1408
Mailing Address - Country:US
Mailing Address - Phone:818-790-1088
Mailing Address - Fax:818-790-1778
Practice Address - Street 1:1818 VERDUGO BLVD STE 200
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1408
Practice Address - Country:US
Practice Address - Phone:818-790-1088
Practice Address - Fax:818-790-1778
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA47709207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A477090Medicaid
CAWA47709DMedicare ID - Type Unspecified
CA00A477090Medicaid