Healthcare Provider Details

I. General information

NPI: 1275666778
Provider Name (Legal Business Name): FAYE ADELE EGGERDING M.D., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 N EL MOLINO AVE
PASADENA CA
91101-1830
US

IV. Provider business mailing address

99 N EL MOLINO AVE
PASADENA CA
91101-1830
US

V. Phone/Fax

Practice location:
  • Phone: 626-795-4343
  • Fax: 626-795-5774
Mailing address:
  • Phone: 626-795-4343
  • Fax: 626-795-5774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberG38233
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: