Healthcare Provider Details

I. General information

NPI: 1659591832
Provider Name (Legal Business Name): MAHFOUZ M. MICHAEL,M.D.,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2007
Last Update Date: 08/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

954 N VERMONT AVE
LOS ANGELES CA
90029-3529
US

IV. Provider business mailing address

PO BOX 291040
LOS ANGELES CA
90029-9040
US

V. Phone/Fax

Practice location:
  • Phone: 323-666-6866
  • Fax: 323-666-9996
Mailing address:
  • Phone: 818-994-0804
  • Fax: 919-994-1288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MAHFOUZ M. MICHAEL
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 818-994-0804