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General NPI Number Information
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NPI Number | 1588204432
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Entity Type | Individual
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Provider Name | MARY HADDADIN
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Gender | Female
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Dates
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Enumeration Date | 01/08/2020
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Last Update Date | 01/08/2020
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Provider Practice Location Address
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Address Line | 1300 YORK AVE RM C-302
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City | NEW YORK
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State | NY
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Zip | 10065-4805
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Country | US
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Telephone | 212-746-6464
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Fax |
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Provider Business Mailing Address
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Address Line | 26531 ESTACIERO DR
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City | MISSION VIEJO
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State | CA
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Zip | 92691
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Country | US
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Telephone | 949-485-1551
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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 | 207ZH0000X
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Taxonomy Name | Hematology (Pathology) Physician
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License Number | 390200000X
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License Number State | NY
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