Healthcare Provider Details

I. General information

NPI: 1851571020
Provider Name (Legal Business Name): JOHN PAUL MADANAT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RAOUF SAMEH MADANAT MD

II. Dates (important events)

Enumeration Date: 11/05/2007
Last Update Date: 01/10/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 WHEELER AVE SUITE C
ARCADIA CA
91006-3220
US

IV. Provider business mailing address

125 WHEELER AVE SUITE C
ARCADIA CA
91006-3220
US

V. Phone/Fax

Practice location:
  • Phone: 626-294-4866
  • Fax: 516-570-3527
Mailing address:
  • Phone: 626-294-4866
  • Fax: 516-570-3527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA110657
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: