Provider Demographics
NPI:1104045061
Name:MAHFOUZ M. MICHAEL,M.D.,INC.
Entity Type:Organization
Organization Name:MAHFOUZ M. MICHAEL,M.D.,INC.
Other - Org Name:CLINICA MEDICA SAN MIGUEL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAHFOUZ
Authorized Official - Middle Name:M
Authorized Official - Last Name:MICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-266-6432
Mailing Address - Street 1:PO BOX 291040
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-9040
Mailing Address - Country:US
Mailing Address - Phone:818-994-0804
Mailing Address - Fax:818-994-1288
Practice Address - Street 1:7119 RITA AVE
Practice Address - Street 2:SUITE C, E, F
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-4781
Practice Address - Country:US
Practice Address - Phone:323-582-4980
Practice Address - Fax:323-582-4914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR001685BMedicaid
CAW7196IMedicare PIN