Provider Demographics
NPI:1154726339
Name:EL FATMI MEDICAL CORPORATION
Entity type:Organization
Organization Name:EL FATMI MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MOUNIR
Authorized Official - Middle Name:
Authorized Official - Last Name:EL FATMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-658-8265
Mailing Address - Street 1:3299 RIKKARD DR
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-4625
Mailing Address - Country:US
Mailing Address - Phone:201-658-8265
Mailing Address - Fax:888-419-2656
Practice Address - Street 1:3299 RIKKARD DR
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362-4625
Practice Address - Country:US
Practice Address - Phone:201-658-8265
Practice Address - Fax:888-419-2656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA99792207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty