Healthcare Provider Details

I. General information

NPI: 1245420199
Provider Name (Legal Business Name): ISKANDER MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 04/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4477 W 118TH ST STE 301
HAWTHORNE CA
90250-2258
US

IV. Provider business mailing address

4477 W 118TH ST STE 301
HAWTHORNE CA
90250-2258
US

V. Phone/Fax

Practice location:
  • Phone: 310-978-8026
  • Fax: 310-978-1408
Mailing address:
  • Phone: 310-978-8026
  • Fax: 310-978-1408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA39011
License Number StateCA

VIII. Authorized Official

Name: DR. MONA YOUSSEF ISKANDER
Title or Position: PRESIDENT
Credential: MD
Phone: 310-978-8026