Basic Information
| Provider Information | |||||||||
| NPI: | 1053543165 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FTEEH | ||||||||
| FirstName: | GAMIL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 393 E WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911880001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095588242 | ||||||||
| FaxNumber: | 9095580479 | ||||||||
| Practice Location | |||||||||
| Address1: | 250 E CAROLINE ST STE J | ||||||||
| Address2: | |||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924083758 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098351810 | ||||||||
| FaxNumber: | 9098351780 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2009 | ||||||||
| LastUpdateDate: | 06/28/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0402X | A130028 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology with Special Qualifications in Child Neurology |
No ID Information.