Healthcare Provider Details

I. General information

NPI: 1649373622
Provider Name (Legal Business Name): F AL FAISAL MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 09/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 W OLIVE AVE
BURBANK CA
91506-2216
US

IV. Provider business mailing address

1218 W OLIVE AVE
BURBANK CA
91506-2216
US

V. Phone/Fax

Practice location:
  • Phone: 818-845-2255
  • Fax: 818-845-2828
Mailing address:
  • Phone: 818-845-2255
  • Fax: 818-845-2828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. FAWAZ FAISAL
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 818-845-2255