Active NPI
Marwan Gamal Elmubarak
- Contractor
- Tempe, AZ
National Provider Identifier
1376852111
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- 463999
- Practice address
- 2022 E Loma Vista Dr
Tempe, AZ 85282-2926 - Phone
- (480) 861-6490
- NPI assigned
- Sep 28, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 463999 | AZ | Primary |
Addresses
Primary practice location
2022 E Loma Vista Dr
Tempe, AZ 85282-2926
Mailing address
2022 E Loma Vista Dr
Tempe, AZ 85282-2926
Phone (480) 861-6490
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 463999 | Other | AZ | ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 463999 | AZ | MD | Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1285632000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1285632000000",
"number": "1376852111",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2022 E LOMA VISTA DR",
"city": "TEMPE",
"state": "AZ",
"postal_code": "852822926",
"telephone_number": "480-861-6490"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2022 E LOMA VISTA DR",
"city": "TEMPE",
"state": "AZ",
"postal_code": "852822926",
"telephone_number": "480-861-6490"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELMUBARAK",
"first_name": "MARWAN",
"middle_name": "GAMAL",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-09-28",
"last_updated": "2010-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "AZ",
"license": "463999",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM",
"identifier": "463999",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tempe, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.