Provider Demographics
NPI:1801184841
Name:MAYWOOD FAMILY MEDICAL CENTER
Entity type:Organization
Organization Name:MAYWOOD FAMILY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAGAA
Authorized Official - Middle Name:Z
Authorized Official - Last Name:ISKAROUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-522-7413
Mailing Address - Street 1:5920 ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90270-3101
Mailing Address - Country:US
Mailing Address - Phone:323-562-2535
Mailing Address - Fax:323-562-2558
Practice Address - Street 1:5920 ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90270-3101
Practice Address - Country:US
Practice Address - Phone:323-562-2535
Practice Address - Fax:323-562-2558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45155261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center