Maged M Faragalla, MD, Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

MAGED M FARAGALLA, MD, INC

Practice address

3624 Martin Luther King Jr Blvd
Lynwood, CA 90262-2607

Phone

(310) 603-9300

Fax

(310) 603-1200

NPI assigned

Apr 13, 2011

Last updated

Sep 5, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ata O Mehrtash, MD

Title

President / Owner

Phone

(562) 531-3331

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1302652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346803200000",
    "number": "1720378508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3624 MARTIN LUTHER KING JR BLVD",
            "city": "LYNWOOD",
            "state": "CA",
            "postal_code": "902622607",
            "telephone_number": "310-603-9300",
            "fax_number": "310-603-1200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3624 MARTIN LUTHER KING JR BLVD",
            "city": "LYNWOOD",
            "state": "CA",
            "postal_code": "902622607",
            "telephone_number": "310-603-9300",
            "fax_number": "310-603-1200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGED M FARAGALLA, MD, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-13",
        "last_updated": "2012-09-05",
        "status": "A",
        "authorized_official_last_name": "MEHRTASH",
        "authorized_official_first_name": "ATA",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "PRESIDENT / OWNER",
        "authorized_official_telephone_number": "562-531-3331",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1720378508",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Lynwood, CA
• Providers in Lynwood, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.