Provider Demographics
NPI:1033310982
Name:HADDAD, IMAD IBRAHIM (DPM)
Entity Type:Individual
Prefix:DR
First Name:IMAD
Middle Name:IBRAHIM
Last Name:HADDAD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21307 ROMAR ST
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-3030
Mailing Address - Country:US
Mailing Address - Phone:818-718-8849
Mailing Address - Fax:818-718-8849
Practice Address - Street 1:21307 ROMAR ST
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-3030
Practice Address - Country:US
Practice Address - Phone:818-718-8849
Practice Address - Fax:818-718-8849
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3831213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E38311Medicaid
CAE3831AMedicare ID - Type UnspecifiedPROVIDER #