Individual
BASEM FANOUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
14124 FOOTHILL BLVD, SUITE 100, SYLMAR, CA 91342
(818) 367-1012
(818) 367-7570
Mailing address
14124 FOOTHILL BLVD, SUITE 100, SYLMAR, CA 91342
(818) 367-1012
(818) 367-7570
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
A053406
CA
207R00000X
Internal Medicine Physician
A53406
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A534060
—
CA
05
—
A053406
—
CA
Enumeration date
09/14/2006
Last updated
02/18/2020
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