Organization
AGEWELL MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BASEM FARAG (PRESIDENT/MD)
(818) 588-3705
Entity
Organization
Contact information
Practice address
142 W VERDUGO AVE, BURBANK, CA 91502-2132
(818) 588-3705
(818) 588-3685
Mailing address
142 W VERDUGO AVE, BURBANK, CA 91502-2132
(818) 588-3705
(818) 588-3685
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
09/22/2025
Last updated
11/07/2025
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