Provider Demographics
NPI:1679604235
Name:ELSEWAFY, WAGIH ABDELMALAK (MD)
Entity type:Individual
Prefix:DR
First Name:WAGIH
Middle Name:ABDELMALAK
Last Name:ELSEWAFY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23501 CINEMA DRIVE
Mailing Address - Street 2:SUIT 200
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-5622
Mailing Address - Country:US
Mailing Address - Phone:661-288-4800
Mailing Address - Fax:661-254-3094
Practice Address - Street 1:23501 CINEMA DR STE 200
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91355-5430
Practice Address - Country:US
Practice Address - Phone:661-288-4800
Practice Address - Fax:661-254-3094
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA562482084P0804X
CAA0562482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAENK1001OtherLOS ANGELES DMH