Healthcare Provider Details

I. General information

NPI: 1851443675
Provider Name (Legal Business Name): ISSAC HADDAD M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 04/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2990 E COLORADO BLVD 105C
PASADENA CA
91107-4463
US

IV. Provider business mailing address

1446 N HOLLISTON AVE
PASADENA CA
91104-2546
US

V. Phone/Fax

Practice location:
  • Phone: 626-793-3700
  • Fax: 626-793-3702
Mailing address:
  • Phone: 626-296-6762
  • Fax: 626-296-6762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA90074
License Number StateCA

VIII. Authorized Official

Name: DR. ISSAC M. HADDAD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 626-296-6762