Healthcare Provider Details

I. General information

NPI: 1396664645
Provider Name (Legal Business Name): EYAD FAKHREDDINE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2932 FAIRMOUNT AVE APT 1
LA CRESCENTA CA
91214-2807
US

IV. Provider business mailing address

2932 FAIRMOUNT AVE APT 1
LA CRESCENTA CA
91214-2807
US

V. Phone/Fax

Practice location:
  • Phone: 818-355-2602
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License NumberA6F4S4Q6
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: