MEDICARE: DR. FADEL ABDULHAI D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	20A 11553	CA

General Provider Information

NPI Number	:	1477797124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FADEL ABDULHAI D.O.

Provider Business Mailing Address
First Line	:	885 PATRIOT DR STE F
Second Line	:
City	:	MOORPARK
State	:	CA
Zip	:	93021-3353
Country	:	US
Telephone Number	:	805-334-1371
Fax Number	:	805-532-2844

Provider Business Practice Location Address
First Line	:	885 PATRIOT DR STE F
Second Line	:
City	:	MOORPARK
State	:	CA
Zip	:	93021-3353
Country	:	US
Telephone Number	:	805-334-1371
Fax Number	:	805-532-2844

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2009
Last Update Date	:	10/03/2016

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