MEDICARE: MATERNAL & FETAL MEDICINE CENTER OF SOUTHERN CALIF. INC

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	207VM0101X	Maternal & Fetal Medicine Physician

General Provider Information

NPI Number	:	1235697244
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATERNAL & FETAL MEDICINE CENTER OF SOUTHERN CALIF. INC

Provider Business Mailing Address
First Line	:	17220 RAYEN ST
Second Line	:
City	:	SHERWOOD FOREST
State	:	CA
Zip	:	91325-2919
Country	:	US
Telephone Number	:	818-632-6244
Fax Number	:	818-882-2466

Provider Business Practice Location Address
First Line	:	17220 RAYEN ST
Second Line	:
City	:	SHERWOOD FOREST
State	:	CA
Zip	:	91325-2919
Country	:	US
Telephone Number	:	818-632-6244
Fax Number	:	818-882-2466

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KHALIL MA TABSH
Credential	:	M.D.
Telephone Number	:	310-701-9521

Provider Enumeration Date	:	03/08/2019
Last Update Date	:	03/08/2019

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