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General NPI Number Information
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NPI Number | 1083830350
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Entity Type | Individual
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Provider Name | ASHRAF F FANOUS M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 08/23/2023
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Provider Practice Location Address
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Address Line | 8775 AERO DR STE 238
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City | SAN DIEGO
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State | CA
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Zip | 92123-1756
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Country | US
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Telephone | 571-232-6708
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Fax |
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Provider Business Mailing Address
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Address Line | 800 THE MARK LN UNIT 1702
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City | SAN DIEGO
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State | CA
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Zip | 92101-7166
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Country | US
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Telephone | 571-232-6708
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A89046
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License Number State | CA
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