Healthcare Provider Details

I. General information

NPI: 1275340234
Provider Name (Legal Business Name): FADYA MIKHAEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2024
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 BISON AVE
NEWPORT BEACH CA
92660-9071
US

IV. Provider business mailing address

461 21ST AVE S
NASHVILLE TN
37240-2455
US

V. Phone/Fax

Practice location:
  • Phone: 949-942-1659
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95037465
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: