Provider Demographics
NPI:1154531218
Name:MOTASFA A HAMDY MD INC
Entity type:Organization
Organization Name:MOTASFA A HAMDY MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOTASFA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAMDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-353-5000
Mailing Address - Street 1:1600 S IMPERIAL AVE
Mailing Address - Street 2:8
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-4242
Mailing Address - Country:US
Mailing Address - Phone:760-353-5000
Mailing Address - Fax:760-370-3229
Practice Address - Street 1:605 W H ST
Practice Address - Street 2:110
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-4200
Practice Address - Country:US
Practice Address - Phone:760-344-7976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43951207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A439510Medicaid
CA1780670836Medicare UPIN
CA00A439510Medicaid
CA1154531218Medicare PIN