Provider Demographics
NPI:1629851399
Name:MAHFOUZ M. MICHAEL,M.D., INC.
Entity Type:Organization
Organization Name:MAHFOUZ M. MICHAEL,M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MAHFOUZ
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-581-0101
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:323-581-0101
Mailing Address - Fax:213-289-2133
Practice Address - Street 1:5421 PACIFIC BLVD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-2532
Practice Address - Country:US
Practice Address - Phone:323-581-0101
Practice Address - Fax:213-289-2133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty