Basic Information
| Provider Information | |||||||||
| NPI: | 1679604235 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ELSEWAFY | ||||||||
| FirstName: | WAGIH | ||||||||
| MiddleName: | ABDELMALAK | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23501 CINEMA DRIVE | ||||||||
| Address2: | SUIT 200 | ||||||||
| City: | SANTA CLARITA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913555622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612884800 | ||||||||
| FaxNumber: | 6612543094 | ||||||||
| Practice Location | |||||||||
| Address1: | 23501 CINEMA DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | SANTA CLARITA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913555430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612884800 | ||||||||
| FaxNumber: | 6612543094 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | A056248 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | ENK1001 | 01 | CA | LOS ANGELES DMH | OTHER |