Provider Demographics
NPI:1013212430
Name:FAYAD, HOUSSAM (MD)
Entity Type:Individual
Prefix:MR
First Name:HOUSSAM
Middle Name:
Last Name:FAYAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31569 CANYON ESTATES DR STE 225
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92532-0472
Mailing Address - Country:US
Mailing Address - Phone:951-228-9010
Mailing Address - Fax:951-609-2080
Practice Address - Street 1:31569 CANYON ESTATES DR STE 225
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92532-0472
Practice Address - Country:US
Practice Address - Phone:951-228-9010
Practice Address - Fax:951-609-2080
Is Sole Proprietor?:No
Enumeration Date:2011-01-14
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY263070208000000X
CT050118208000000X
CA133149208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics