Provider Demographics
NPI:1831380278
Name:SALIB, AMGAD G (MD)
Entity type:Individual
Prefix:
First Name:AMGAD
Middle Name:G
Last Name:SALIB
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 1:150 TEJAS PL
Mailing Address - Street 2:PO BOX 430
Mailing Address - City:NIPOMO
Mailing Address - State:CA
Mailing Address - Zip Code:93444-9123
Mailing Address - Country:US
Mailing Address - Phone:805-929-3211
Mailing Address - Fax:805-929-6440
Practice Address - Street 1:7512 MORRO RD
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-4404
Practice Address - Country:US
Practice Address - Phone:805-792-1400
Practice Address - Fax:805-792-1485
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA100907207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC71030FMedicaid
CACO916WMedicare PIN
CAW1508Medicare PIN
CAW1508AMedicare PIN
CACO916ZMedicare PIN
CACO916XMedicare PIN
CAW1508EMedicare UPIN
CAW1508CMedicare PIN
CACO916YMedicare PIN
CAFHC71030FMedicaid