Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 35.045782 | OH |
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | C50556 | CA |
N | 207R00000X | Internist | C50556 | CA |
N | 111NI0900X | Internist | C50556 | CA |
NPI | 1376573030 |
---|---|
Provider Name | Mohamed Waddah El-Nachef |
First Address | Orange, CA 92859-8083 |
Second Address | Santa Ana, CA 92705-3502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 08/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
05454317 | (05) | OH |