Healthcare Provider Details

I. General information

NPI: 1609840479
Provider Name (Legal Business Name): ANAN ADNAN FAIDI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 N CENTER ST
STOCKTON CA
95202-1312
US

IV. Provider business mailing address

930 N CENTER ST
STOCKTON CA
95202-1312
US

V. Phone/Fax

Practice location:
  • Phone: 209-948-3000
  • Fax: 209-948-3127
Mailing address:
  • Phone: 209-948-3000
  • Fax: 209-948-3127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberA48562
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: