Healthcare Provider Details

I. General information

NPI: 1740590587
Provider Name (Legal Business Name): MAFA R KAMAL M D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2010
Last Update Date: 05/28/2020
Certification Date: 05/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E LONGDEN AVE
ARCADIA CA
91006-5242
US

IV. Provider business mailing address

PO BOX 942
TEMPLE CITY CA
91780-0942
US

V. Phone/Fax

Practice location:
  • Phone: 213-481-0022
  • Fax: 213-357-5408
Mailing address:
  • Phone: 213-481-0022
  • Fax: 213-481-2338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MAFA RIBHI KAMAL
Title or Position: CEO
Credential: MD
Phone: 213-481-0022