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NPI Code Detail

MEDICARE: MAISAA FADUL

MEDICARE: MAISAA FADUL
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
1183500000XPharmacist82461CA

General Provider Information

NPI Number : 1639890338
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAISAA FADUL
Provider Business Mailing Address
First Line : 883 S SANTA FE AVE
Second Line :
City : VISTA
State : CA
Zip : 92083-5237
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 883 S SANTA FE AVE
Second Line :
City : VISTA
State : CA
Zip : 92083-5237
Country : US
Telephone Number : 425-954-0830
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/09/2022
Last Update Date : 09/12/2022

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Directions to “ MAISAA FADUL ” Practice Location

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