Provider Demographics
NPI:1063512473
Name:EL-BIALY, ADEL K (MD)
Entity type:Individual
Prefix:DR
First Name:ADEL
Middle Name:K
Last Name:EL-BIALY
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 1:15243 VANOWEN ST
Mailing Address - Street 2:SUITE # 301
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-3605
Mailing Address - Country:US
Mailing Address - Phone:818-782-5041
Mailing Address - Fax:818-205-9091
Practice Address - Street 1:23928 LYONS AVE STE 201
Practice Address - Street 2:
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2454
Practice Address - Country:US
Practice Address - Phone:661-254-6600
Practice Address - Fax:661-254-6603
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53313207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A533130Medicaid
CACQ825ZMedicare PIN
CAG45675Medicare UPIN
CA00A533130Medicaid
CACQ825RMedicare PIN
CACQ825YMedicare PIN
CACQ825UMedicare PIN
CACQ825XMedicare PIN
CACQ825SMedicare PIN
CACQ825WMedicare PIN