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General NPI Number Information
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NPI Number | 1487234316
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Entity Type | Organization
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Legal Business Name | MEHDI FAKHRAI MD, F.I.C.S., F.A.C.S., MEDICAL CORPORATION
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Dates
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Enumeration Date | 04/14/2021
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Last Update Date | 04/14/2021
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Provider Practice Location Address
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Address Line | 10605 BALBOA BLVD STE 225
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City | GRANADA HILLS
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State | CA
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Zip | 91344-6376
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Country | US
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Telephone | 818-898-3939
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Fax | 818-898-1663
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Provider Business Mailing Address
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Address Line | 10605 BALBOA BLVD STE 225
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City | GRANADA HILLS
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State | CA
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Zip | 91344-6376
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Country | US
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Telephone | 818-898-3939
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Fax | 818-898-1663
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MEHDI FAKHRAI
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Credential | MD
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Telephone | 818-898-3939
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number |
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License Number State |
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