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Organization
MAGED M FARAGALLA, MD, INC
Active
Organization
MAGED M FARAGALLA, MD, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ATA O MEHRTASH MD (PRESIDENT / OWNER)
(562) 531-3331
Entity
Organization
Contact information
Practice address
3624 MARTIN LUTHER KING JR BLVD, LYNWOOD, CA 90262-2607
(310) 603-9300
(310) 603-1200
Mailing address
3624 MARTIN LUTHER KING JR BLVD, LYNWOOD, CA 90262-2607
(310) 603-9300
(310) 603-1200
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1720378508
—
CA
Enumeration date
04/13/2011
Last updated
09/05/2012
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