Provider Demographics
NPI:1154774933
Name:GUIRGIS, IMAN
Entity type:Individual
Prefix:
First Name:IMAN
Middle Name:
Last Name:GUIRGIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3812 MONTEGO DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-2006
Mailing Address - Country:US
Mailing Address - Phone:949-903-2601
Mailing Address - Fax:
Practice Address - Street 1:825 COXWELL AVENUE
Practice Address - Street 2:
Practice Address - City:TORONTO
Practice Address - State:ONTARIO
Practice Address - Zip Code:M4C 3E7
Practice Address - Country:CA
Practice Address - Phone:416-469-6580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC55832207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine