Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 000000A52053 | CA |
NPI | 1124108204 |
---|---|
Provider Name | Fayez M Bany-Mohammed |
First Address | Los Angeles, CA 90051-3356 |
Second Address | Orange, CA 92868 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 08/07/2007 |