Organization
BASEM FANOUS, M.D. A PROFESSIONAL CORPORATION
Active
Other names
N/A
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BASEM FANOUS MD (CEO)
(818) 486-8138
Entity
Organization
Contact information
Practice address
14124 FOOTHILL BLVD STE 100, SYLMAR, CA 91342-8051
(818) 486-8138
(818) 486-8138
Mailing address
20312 HOWARD CT, WOODLAND HILLS, CA 91364-5668
(818) 486-8138
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
363AM0700X
Medical Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
01/29/2025
Last updated
01/29/2025
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