Healthcare Provider Details

I. General information

NPI: 1528234051
Provider Name (Legal Business Name): NAGWA FOUAD MINA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2008
Last Update Date: 07/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44216 10TH ST W
LANCASTER CA
93534-4134
US

IV. Provider business mailing address

200 OCEANGATE SUITE 100
LONG BEACH CA
90802-4302
US

V. Phone/Fax

Practice location:
  • Phone: 661-723-7416
  • Fax: 661-723-9975
Mailing address:
  • Phone: 562-499-6191
  • Fax: 562-499-6171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA101771
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: