Healthcare Provider Details

I. General information

NPI: 1073618633
Provider Name (Legal Business Name): MICHAEL FAROUK HABASHY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 W ALAMEDA AVE SUIT # 516
BURBANK CA
91505-4806
US

IV. Provider business mailing address

2625 W ALAMEDA AVE SUIT AVE 516
BURBANK CA
91505-4806
US

V. Phone/Fax

Practice location:
  • Phone: 818-729-9111
  • Fax: 818-729-9992
Mailing address:
  • Phone: 818-729-9111
  • Fax: 818-729-9992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA83772
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA83772
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: