Healthcare Provider Details

I. General information

NPI: 1609095660
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: 09/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 N PARK AVE
POMONA CA
91768-3002
US

IV. Provider business mailing address

PO BOX 1680
POMONA CA
91769-1680
US

V. Phone/Fax

Practice location:
  • Phone: 909-622-9988
  • Fax: 909-622-0882
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 Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

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