Healthcare Provider Details

I. General information

NPI: 1215903158
Provider Name (Legal Business Name): DAVID ERIC SCAFIDI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36320 INLAND VALLEY DR STE 101
WILDOMAR CA
92595-7512
US

IV. Provider business mailing address

DEPT LA 21693
PASADENA CA
91185-1693
US

V. Phone/Fax

Practice location:
  • Phone: 951-600-3811
  • Fax:
Mailing address:
  • Phone: 858-564-1400
  • Fax: 858-564-1500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG80079
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: