Provider Demographics
NPI:1912956525
Name:EL ASMAR, IMAD AZIZ (MD)
Entity Type:Individual
Prefix:
First Name:IMAD
Middle Name:AZIZ
Last Name:EL ASMAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:IMAD
Other - Middle Name:AZIZ
Other - Last Name:EL ASMAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1234 N VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-1704
Mailing Address - Country:US
Mailing Address - Phone:323-660-5624
Mailing Address - Fax:213-487-6811
Practice Address - Street 1:1234 N VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-1704
Practice Address - Country:US
Practice Address - Phone:323-660-5624
Practice Address - Fax:213-487-6811
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61923207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFO552ZMedicare PIN
CAWA61923BMedicare PIN
CAWA61923CMedicare PIN