Provider Demographics
NPI:1386813103
Name:EL-BERSHAWI MEDICAL CORP
Entity type:Organization
Organization Name:EL-BERSHAWI MEDICAL CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:EL-BERSHAWI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-781-3672
Mailing Address - Street 1:4234 RIVERWALK PKWY
Mailing Address - Street 2:SUITE 230
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-8510
Mailing Address - Country:US
Mailing Address - Phone:951-781-3672
Mailing Address - Fax:951-781-0365
Practice Address - Street 1:4234 RIVERWALK PKWY
Practice Address - Street 2:SUITE 230
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-8510
Practice Address - Country:US
Practice Address - Phone:951-781-3672
Practice Address - Fax:951-781-0365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90658207R00000X, 207RC0200X, 207RP1001X, 207RS0012X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ07188ZMedicare PIN