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General NPI Number Information
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NPI Number | 1912381294
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Entity Type | Organization
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Legal Business Name | KYRILLOS MEDICAL GROUP,INC
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Dates
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Enumeration Date | 07/16/2015
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Last Update Date | 07/16/2015
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Provider Practice Location Address
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Address Line | 1510 S CENTRAL AVE SUITE 250
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City | GLENDALE
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State | CA
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Zip | 91204-2500
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Country | US
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Telephone | 818-502-0325
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Fax | 818-242-5079
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Provider Business Mailing Address
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Address Line | 1510 S CENTRAL AVE SUITE 250
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City | GLENDALE
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State | CA
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Zip | 91204-2500
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Country | US
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Telephone | 818-502-0325
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Fax | 818-242-5079
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Authorized Official
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Title or Position | CEO
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Name | MICHAEL FAROUK HABASHY
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Credential | M.D.
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Telephone | 818-391-9193
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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