Individual
DR. FAWZY SAMY BASTA SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
17075 DEVONSHIRE ST, STE 204, NORTHRIDGE, CA 91325-5408
(818) 368-8929
(818) 368-8940
Mailing address
17075 DEVONSHIRE ST, STE 204, NORTHRIDGE, CA 91325-1600
(818) 368-8929
(818) 368-8940
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
A42961
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0A429611
—
CA
Enumeration date
10/24/2006
Last updated
01/20/2012
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