Healthcare Provider Details

I. General information

NPI: 1194774034
Provider Name (Legal Business Name): MAGUED RASSEM FADLY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23018 VENTURA BLVD
WOODLAND HILLS CA
91364-1108
US

IV. Provider business mailing address

11862 BALBOA BLVD # 195
GRANADA HILLS CA
91344-2753
US

V. Phone/Fax

Practice location:
  • Phone: 818-225-0045
  • Fax: 818-225-0142
Mailing address:
  • Phone: 818-406-7696
  • Fax: 818-225-0142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA64236
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: