Healthcare Provider Details

I. General information

NPI: 1316389141
Provider Name (Legal Business Name): NAZIH M. HADDAD, MD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2013
Last Update Date: 03/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 NEWPORT CENTER DR 704
NEWPORT BEACH CA
92660-7601
US

IV. Provider business mailing address

400 NEWPORT CENTER DR 704
NEWPORT BEACH CA
92660-7601
US

V. Phone/Fax

Practice location:
  • Phone: 949-720-0505
  • Fax: 949-720-0534
Mailing address:
  • Phone: 949-720-0505
  • Fax: 949-720-0534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA31234
License Number StateCA

VIII. Authorized Official

Name: NAZIH HADDAD
Title or Position: PROVIDER
Credential: MD
Phone: 949-720-0505