Organization
FAWZY BASTA M D A PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FAWZY SAMY BASTA MD (OWNER)
(818) 368-8929
Entity
Organization
Contact information
Practice address
17075 DEVONSHIRE ST, SUITE 204, NORTHRIDGE, CA 91325-1600
(818) 368-8929
(818) 368-8720
Mailing address
17075 DEVONSHIRE ST, SUITE 204, NORTHRIDGE, CA 91325-1600
(818) 368-8929
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
A42961
CA
Other
Enumeration date
11/28/2006
Last updated
04/30/2024
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