Provider Demographics
NPI:1811183304
Name:FAYEK, MOHAMED HASSAN (MD)
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:HASSAN
Last Name:FAYEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:28 MONARCH BAY PLZ
Mailing Address - Street 2:SUITE N
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-3460
Mailing Address - Country:US
Mailing Address - Phone:949-489-5564
Mailing Address - Fax:949-496-8872
Practice Address - Street 1:28 MONARCH BAY PLZ
Practice Address - Street 2:SUITE N
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-3460
Practice Address - Country:US
Practice Address - Phone:949-489-5564
Practice Address - Fax:949-496-8872
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA722822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry