Provider Demographics
NPI:1396799052
Name:FOUAD, HANY C (MD)
Entity type:Individual
Prefix:
First Name:HANY
Middle Name:C
Last Name:FOUAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5051 VERDUGO WAY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012
Mailing Address - Country:US
Mailing Address - Phone:805-384-8071
Mailing Address - Fax:805-987-1927
Practice Address - Street 1:5051 VERDUGO WAY
Practice Address - Street 2:SUITE 110
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012
Practice Address - Country:US
Practice Address - Phone:805-384-8071
Practice Address - Fax:805-987-1927
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85094207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM08608FMedicaid
CA050394OtherBLUE CROSS
CA951683892OtherOTHER INSURANCE
CARHM18553HMedicaid
CAZZT40394FMedicaid
CARHM08609FMedicaid
CAZZT40394FMedicaid
CARHM08609FMedicaid
CA058609Medicare ID - Type UnspecifiedRH MEDICARE
CAWA85094KMedicare ID - Type UnspecifiedPPIN
CARHM18553HMedicaid
CA058608Medicare ID - Type UnspecifiedRH MEDICARE
CAWA85094IMedicare ID - Type UnspecifiedPPIN
CA058553Medicare ID - Type UnspecifiedRH MEDICARE
CAWA85094FMedicare ID - Type UnspecifiedPPIN
CAWA85094GMedicare ID - Type UnspecifiedPPIN
CAWA85094HMedicare ID - Type UnspecifiedPPIN
CAWA85094EMedicare ID - Type UnspecifiedPPIN