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General NPI Number Information
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NPI Number | 1730992009
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Entity Type | Organization
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Legal Business Name | BASEM FANOUS, M.D. A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 01/29/2025
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 14124 FOOTHILL BLVD STE 100
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City | SYLMAR
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State | CA
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Zip | 91342-8051
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Country | US
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Telephone | 818-486-8138
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Fax | 818-486-8138
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Provider Business Mailing Address
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Address Line | 20312 HOWARD CT
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City | WOODLAND HILLS
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State | CA
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Zip | 91364-5668
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Country | US
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Telephone | 818-486-8138
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. BASEM FANOUS
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Credential | MD
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Telephone | 818-486-8138
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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