Healthcare Provider Details

I. General information

NPI: 1780797902
Provider Name (Legal Business Name): TAWFIK TIM HADAYA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38660 MEDICAL CENTER DR # A200
PALMDALE CA
93551-4385
US

IV. Provider business mailing address

44105 N 15TH ST W #302
LANCASTER CA
93534-4089
US

V. Phone/Fax

Practice location:
  • Phone: 661-949-3006
  • Fax: 661-949-8770
Mailing address:
  • Phone: 661-949-3006
  • Fax: 661-949-8770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberA39485
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: