MEDICARE: DR. ASHRAF F FANOUS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	A89046	CA

General Provider Information

NPI Number	:	1083830350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ASHRAF F FANOUS M.D.

Provider Business Mailing Address
First Line	:	800 THE MARK LN UNIT 1702
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-7166
Country	:	US
Telephone Number	:	571-232-6708
Fax Number	:

Provider Business Practice Location Address
First Line	:	8775 AERO DR STE 238
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1756
Country	:	US
Telephone Number	:	571-232-6708
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	08/23/2023

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