Healthcare Provider Details

I. General information

NPI: 1689692956
Provider Name (Legal Business Name): DR. FADI HADDAD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 03/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8860 CENTER DR SUITE 320
LA MESA CA
91942-3068
US

IV. Provider business mailing address

8860 CENTER DR SUITE 320
LA MESA CA
91942-3068
US

V. Phone/Fax

Practice location:
  • Phone: 619-376-1904
  • Fax:
Mailing address:
  • Phone: 619-376-1904
  • Fax: 619-376-1909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberA80687
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: