Provider Demographics
NPI:1023043635
Name:RABADI, FARES (MD)
Entity Type:Individual
Prefix:DR
First Name:FARES
Middle Name:
Last Name:RABADI
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 1:18350 ROSCOE BLVD
Mailing Address - Street 2:SUITE 514
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4109
Mailing Address - Country:US
Mailing Address - Phone:818-775-0519
Mailing Address - Fax:818-775-0943
Practice Address - Street 1:18350 ROSCOE BLVD
Practice Address - Street 2:SUITE 514
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4109
Practice Address - Country:US
Practice Address - Phone:818-775-0519
Practice Address - Fax:818-775-0943
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66578207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A665780Medicaid
CAA66578Medicare ID - Type UnspecifiedPROVIDER NUMBER