Provider Demographics
NPI:1235697244
Name:MATERNAL & FETAL MEDICINE CENTER OF SOUTHERN CALIF. INC
Entity Type:Organization
Organization Name:MATERNAL & FETAL MEDICINE CENTER OF SOUTHERN CALIF. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KHALIL
Authorized Official - Middle Name:MA
Authorized Official - Last Name:TABSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-701-9521
Mailing Address - Street 1:17220 RAYEN ST
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:91325-2919
Mailing Address - Country:US
Mailing Address - Phone:818-632-6244
Mailing Address - Fax:818-882-2466
Practice Address - Street 1:17220 RAYEN ST
Practice Address - Street 2:
Practice Address - City:SHERWOOD FOREST
Practice Address - State:CA
Practice Address - Zip Code:91325-2919
Practice Address - Country:US
Practice Address - Phone:818-632-6244
Practice Address - Fax:818-882-2466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty