Healthcare Provider Details

I. General information

NPI: 1588305148
Provider Name (Legal Business Name): FATEN FETYAN MOHAMED AHMED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 W. CARSON STREET, RB-3 BOX 467
TORRANCE CA
90502-2006
US

IV. Provider business mailing address

1124 W. CARSON STREET, RB-3 BOX 467
TORRANCE CA
90502-2006
US

V. Phone/Fax

Practice location:
  • Phone: 424-571-7769
  • Fax:
Mailing address:
  • Phone: 424-571-7769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberA203445
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: