Healthcare Provider Details

I. General information

NPI: 1508085515
Provider Name (Legal Business Name): MAHFOUZ M. MICHAEL,M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 05/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7542 LAUREL CANYON BLVD 7540 LAUREL CANYON BLVD.
NORTH HOLLYWOOD CA
91605-3148
US

IV. Provider business mailing address

PO BOX 291040
LOS ANGELES CA
90029-9040
US

V. Phone/Fax

Practice location:
  • Phone: 818-765-0503
  • Fax: 818-765-5908
Mailing address:
  • Phone: 818-994-0804
  • Fax: 818-994-1288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MAHFOUZ M MICHAEL
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 818-266-6432