# MAHFOUZ M. MICHAEL,M.D.,INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Clinica Medica San Miguel
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104045210
- **Authorized official:** DR. MAHFOUZ M. MICHAEL M.D. (MEDICAL DIRECTOR)
- **Authorized official phone:** (818) 994-0804

## Contact information

- **Practice address:** 1437 S ATLANTIC BLVD, LOS ANGELES, CA 90022-5015
- **Practice address phone:** (323) 268-9900
- **Practice address fax:** (323) 268-4993
- **Mailing address:** PO BOX 291040, LOS ANGELES, CA 90029-9040
- **Mailing address phone:** (818) 994-0804
- **Mailing address fax:** (818) 994-1288

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207RC0000X | Cardiovascular Disease Physician | — | NULL | — |
| 207RC0000X | Cardiovascular Disease Physician | — | — | — |
| 207RR0500X | Rheumatology Physician | — | NULL | — |
| 207RR0500X | Rheumatology Physician | — | — | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | — |
| 207W00000X | Ophthalmology Physician | — | NULL | — |
| 207W00000X | Ophthalmology Physician | — | — | — |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |
| 2086S0129X | Vascular Surgery Physician | — | NULL | — |
| 2086S0129X | Vascular Surgery Physician | — | — | — |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/25/2007
- **Last updated:** 08/22/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | GR0029510 | — | CA |