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General NPI Number Information
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NPI Number | 1720378508
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Entity Type | Organization
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Legal Business Name | MAGED M FARAGALLA, MD, INC
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Dates
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Enumeration Date | 04/13/2011
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Last Update Date | 09/05/2012
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Provider Practice Location Address
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Address Line | 3624 MARTIN LUTHER KING JR BLVD
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City | LYNWOOD
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State | CA
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Zip | 90262-2607
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Country | US
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Telephone | 310-603-9300
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Fax | 310-603-1200
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Provider Business Mailing Address
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Address Line | 3624 MARTIN LUTHER KING JR BLVD
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City | LYNWOOD
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State | CA
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Zip | 90262-2607
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Country | US
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Telephone | 310-603-9300
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Fax | 310-603-1200
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Authorized Official
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Title or Position | PRESIDENT / OWNER
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Name | ATA O MEHRTASH
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Credential | MD
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Telephone | 562-531-3331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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