| Maged M Faragalla, MD, Inc | |
|
3624 Martin Luther King Jr Blvd Lynwood CA 90262-2607 | |
| (310) 603-9300 | |
| (310) 603-1200 |
| Full Name | Maged M Faragalla, MD, Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 3624 Martin Luther King Jr Blvd, Lynwood, California |
| Authorized Official Name and Position | Ata O Mehrtash (PRESIDENT / OWNER) |
| Authorized Official Contact | 5625313331 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Maged M Faragalla, MD, Inc 3624 Martin Luther King Jr Blvd Lynwood CA 90262-2607 Ph: (310) 603-9300 | Maged M Faragalla, MD, Inc 3624 Martin Luther King Jr Blvd Lynwood CA 90262-2607 Ph: (310) 603-9300 |
| NPI Number | 1720378508 |
|---|---|
| Provider Enumeration Date | 04/13/2011 |
| Last Update Date | 09/05/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720378508 | NPI | - | NPPES |
| 1720378508 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (NU) | Primary |
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