| Fawzy Basta M D A Professional Corporation | |
|
17075 Devonshire St Suite 204 Northridge CA 91325-1600 | |
| (818) 368-8929 | |
| (818) 368-8720 |
| Full Name | Fawzy Basta M D A Professional Corporation |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 17075 Devonshire St, Northridge, California |
| Authorized Official Name and Position | Fawzy Samy Basta (OWNER) |
| Authorized Official Contact | 8183688929 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fawzy Basta M D A Professional Corporation 17075 Devonshire St Suite 204 Northridge CA 91325-1600 Ph: (818) 368-8929 | Fawzy Basta M D A Professional Corporation 17075 Devonshire St Suite 204 Northridge CA 91325-1600 Ph: (818) 368-8929 |
| NPI Number | 1508932500 |
|---|---|
| Provider Enumeration Date | 11/28/2006 |
| Last Update Date | 04/30/2024 |
| Certification Date | 04/30/2024 |
| Medicare PECOS PAC ID | 4880639814 |
|---|---|
| Medicare Enrollment ID | O20050621000763 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508932500 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | A42961 (California) | Primary |
| Provider Name | Fawzy S Basta |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1043394505 PECOS PAC ID: 8426093451 Enrollment ID: I20101124000589 |
| Provider Name | Todd Nathan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861734428 PECOS PAC ID: 1951525831 Enrollment ID: I20140616001525 |
| Provider Name | Tracy Le Henry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295249225 PECOS PAC ID: 8022377381 Enrollment ID: I20180111001518 |
| Provider Name | Gerard Tcheumani |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306356878 PECOS PAC ID: 8426479650 Enrollment ID: I20200526002557 |
| Provider Name | Karine Setyan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194464693 PECOS PAC ID: 2365823119 Enrollment ID: I20220725003563 |
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