MEDICARE: DR. EMAD GUIRGUS TADROS MD

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	2084P0800X	Psychiatry Physician	A49500	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	91504830158	OTHER	MEID
2	36378166594C	OTHER	ECFMG
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487696878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMAD GUIRGUS TADROS MD

Provider Business Mailing Address
First Line	:	510 W VISTA WAY
Second Line	:
City	:	VISTA
State	:	CA
Zip	:	92083-5704
Country	:	US
Telephone Number	:	858-775-2122
Fax Number	:	619-291-4426

Provider Business Practice Location Address
First Line	:	3914 THIRD AVENUE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-3095
Country	:	US
Telephone Number	:	619-291-4808
Fax Number	:	619-291-4426

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

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	09/30/2024

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