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General NPI Number Information
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NPI Number | 1922241736
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Entity Type | Organization
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Legal Business Name | MAURICE SHAFIK GHATTAS MD A PROFESSIONAL CORP
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Dates
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Enumeration Date | 04/08/2009
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Last Update Date | 04/27/2009
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Provider Practice Location Address
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Address Line | 11180 WARNER AVE SUITE#259
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-7501
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Country | US
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Telephone | 714-546-0099
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Fax | 714-546-0009
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Provider Business Mailing Address
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Address Line | 11180 WARNER AVE SUITE # 259
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-7501
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Country | US
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Telephone | 714-546-0099
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Fax | 714-546-0009
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Authorized Official
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Title or Position | PRESIDENT
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Name | MAURICE SHAFIK GHATTAS
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Credential | M.D.
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Telephone | 714-546-0099
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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 | A35441
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License Number State | CA
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