MEDICARE: F AL FAISAL MD 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	207T00000X	Neurological Surgery Physician
2	2084N0400X	Neurology Physician

General Provider Information

NPI Number	:	1649373622
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	F AL FAISAL MD INC

Provider Business Mailing Address
First Line	:	1218 W OLIVE AVE
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91506-2216
Country	:	US
Telephone Number	:	818-845-2255
Fax Number	:	818-845-2828

Provider Business Practice Location Address
First Line	:	1218 W OLIVE AVE
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91506-2216
Country	:	US
Telephone Number	:	818-845-2255
Fax Number	:	818-845-2828

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	DR. FAWAZ FAISAL
Credential	:	M.D.
Telephone Number	:	818-845-2255

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	09/16/2019

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