Healthcare Provider Details

I. General information

NPI: 1598692980
Provider Name (Legal Business Name): SAAD A ADAWY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10950 CHURCH ST # 4011A1
RANCHO CUCAMONGA CA
91730-8955
US

IV. Provider business mailing address

10950 CHURCH ST # 4011A1
RANCHO CUCAMONGA CA
91730-8955
US

V. Phone/Fax

Practice location:
  • Phone: 951-731-8679
  • Fax: 909-652-0005
Mailing address:
  • Phone: 951-731-8679
  • Fax: 909-652-0005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberY3028326
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: