Provider Demographics
NPI:1053590349
Name:FADI A. HADDAD, M.D., INC.
Entity type:Organization
Organization Name:FADI A. HADDAD, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FADI
Authorized Official - Middle Name:A
Authorized Official - Last Name:HADDAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-376-1904
Mailing Address - Street 1:8860 CENTER DR STE 320
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-7001
Mailing Address - Country:US
Mailing Address - Phone:619-376-1904
Mailing Address - Fax:619-376-1909
Practice Address - Street 1:8860 CENTER DR STE 320
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-7001
Practice Address - Country:US
Practice Address - Phone:619-376-1904
Practice Address - Fax:619-376-1909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH88998Medicare UPIN