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General NPI Number Information
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NPI Number | 1326354069
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Entity Type | Individual
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Provider Name | NISRIN FADUL MD
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Gender | Female
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Dates
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Enumeration Date | 08/19/2010
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Last Update Date | 01/04/2022
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Provider Practice Location Address
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Address Line | 6600 BRUCEVILLE RD
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City | SACRAMENTO
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State | CA
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Zip | 95823-4671
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Country | US
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Telephone | 916-688-6800
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Fax |
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Provider Business Mailing Address
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Address Line | 6600 BRUCEVILLE RD
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City | SACRAMENTO
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State | CA
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Zip | 95823-4671
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Country | US
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Telephone | 916-688-6800
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 4301095978
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 149858
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License Number State | CA
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