Healthcare Provider Details

I. General information

NPI: 1295430528
Provider Name (Legal Business Name): PATRICK M. JADALI DPM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24641 COLEFORD ST
LAKE FOREST CA
92630-3925
US

IV. Provider business mailing address

24641 COLEFORD ST
LAKE FOREST CA
92630-3925
US

V. Phone/Fax

Practice location:
  • Phone: 949-333-9626
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PATRICK JADALI
Title or Position: CEO
Credential: DPM
Phone: 562-285-7372