Provider Demographics
NPI:1154352508
Name:ENGEL, MOSHE DAVID (MD)
Entity type:Individual
Prefix:
First Name:MOSHE
Middle Name:DAVID
Last Name:ENGEL
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 1:1050 S HOLT AVE
Mailing Address - Street 2:APT. 205
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-2021
Mailing Address - Country:US
Mailing Address - Phone:602-717-9448
Mailing Address - Fax:
Practice Address - Street 1:301 E BETHANY HOME RD
Practice Address - Street 2:SUITE A233
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1263
Practice Address - Country:US
Practice Address - Phone:602-717-9448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00033855207P00000X
AZ23102207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG23124Medicare UPIN
CABA084YMedicare PIN
CABA084ZMedicare PIN
CABA084ZMedicare PIN