Provider Demographics
NPI:1457557324
Name:REZK, SHERIF (MD)
Entity Type:Individual
Prefix:DR
First Name:SHERIF
Middle Name:
Last Name:REZK
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:PO BOX 513377
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-3377
Mailing Address - Country:US
Mailing Address - Phone:714-456-8835
Mailing Address - Fax:714-456-6248
Practice Address - Street 1:101 THE CITY DR S
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3201
Practice Address - Country:US
Practice Address - Phone:714-456-6411
Practice Address - Fax:714-456-5873
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93251207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA93251AOtherMEDICARE PTAN
CA00A932510Medicaid
CA00A932510OtherBLUE SHIELD
CAWA93251AMedicare PIN