MEDICARE: RATEB HADDAD

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	213E00000X	Podiatrist	851	FL

General Provider Information

NPI Number	:	1811570476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RATEB HADDAD

Provider Business Mailing Address
First Line	:	10518 SUNBIRD WAY
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95219-7158
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10518 SUNBIRD WAY
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95219-7158
Country	:	US
Telephone Number	:	209-423-0759
Fax Number	:

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

Provider Enumeration Date	:	05/02/2021
Last Update Date	:	02/10/2026

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Directions to “ RATEB HADDAD ” Practice Location

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