Basic Information
| Provider Information | |||||||||
| NPI: | 1578199402 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAHFOUD | ||||||||
| FirstName: | BASSEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2932 N COTTONWOOD ST UNIT 16 | ||||||||
| Address2: | |||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928651235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888513677 | ||||||||
| FaxNumber: | 8888513671 | ||||||||
| Practice Location | |||||||||
| Address1: | 2932 N COTTONWOOD ST UNIT 16 | ||||||||
| Address2: | |||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928651235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888513677 | ||||||||
| FaxNumber: | 8888513671 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2020 | ||||||||
| LastUpdateDate: | 03/23/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0600X | NULL | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Clinical Neurophysiology |
No ID Information.