| NPI | 1730992009 |
|---|---|
| Other Name | N/A |
| Entity Type | Organization |
| Authorized Contact | BASEM FANOUS CEO 818-486-8138 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine |
| 363AM0700X Physician Assistant, Medical | |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2025-01-29 |
| Last Update Date | 2025-01-29 |