Healthcare Provider Details

I. General information

NPI: 1740293299
Provider Name (Legal Business Name): MAFA RIBHI KAMAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 10/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 WILSHIRE BLVD SUITE 500
LOS ANGELES CA
90017-3901
US

IV. Provider business mailing address

PO BOX 942
TEMPLE CITY CA
91780-0942
US

V. Phone/Fax

Practice location:
  • Phone: 213-481-0022
  • Fax: 213-481-2338
Mailing address:
  • Phone: 626-447-3561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA42112
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberA42112
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License NumberA42112
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: