Provider Demographics
NPI:1205912847
Name:MOUKARZEL, ELIAS N (MD)
Entity type:Individual
Prefix:DR
First Name:ELIAS
Middle Name:N
Last Name:MOUKARZEL
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 1:1296 WESTWIND DR
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-4368
Mailing Address - Country:US
Mailing Address - Phone:760-337-2928
Mailing Address - Fax:
Practice Address - Street 1:2109 WEST ROSS AVE
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-3685
Practice Address - Country:US
Practice Address - Phone:760-352-4103
Practice Address - Fax:760-545-0258
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50303207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW13536OtherGROUP PTAN
CA00C503030Medicaid
CA00C503030Medicaid
CAC503030Medicare UPIN