Basic Information
| Provider Information | |||||||||
| NPI: | 1568597250 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OSAMAH A EL-ATTAR MD INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 800817 | ||||||||
| Address2: | |||||||||
| City: | SANTA CLARITA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913800817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6614300935 | ||||||||
| FaxNumber: | 8664311210 | ||||||||
| Practice Location | |||||||||
| Address1: | 1234 N VERMONT AVE | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900291704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3236662726 | ||||||||
| FaxNumber: | 3236669056 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2007 | ||||||||
| LastUpdateDate: | 02/18/2020 | ||||||||
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| AuthorizedOfficialLastName: | EL-ATTAR | ||||||||
| AuthorizedOfficialFirstName: | OSAMAH | ||||||||
| AuthorizedOfficialMiddleName: | AMIN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3236662726 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 02/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | A26314 | CA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207R00000X | A26314 | CA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0011X | A26314 | CA | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 00A263141 | 05 | CA | MEDICAID | 00A263140 | 05 | CA | MEDICAID |