Healthcare Provider Details

I. General information

NPI: 1629175914
Provider Name (Legal Business Name): FADI HANBALI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 03/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E CLIFF DR STE 2A
EL PASO TX
79902-4848
US

IV. Provider business mailing address

1250 E CLIFF DR STE 2A
EL PASO TX
79902-4848
US

V. Phone/Fax

Practice location:
  • Phone: 915-577-7951
  • Fax: 915-577-7952
Mailing address:
  • Phone: 915-577-7951
  • Fax: 915-577-7952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberM1127
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: