Provider Demographics
NPI:1184632606
Name:DADA, FESTUS B (MD)
Entity Type:Individual
Prefix:DR
First Name:FESTUS
Middle Name:B
Last Name:DADA
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 1:25470 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-4900
Mailing Address - Country:US
Mailing Address - Phone:951-973-7290
Mailing Address - Fax:951-973-7299
Practice Address - Street 1:25470 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 203
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-4900
Practice Address - Country:US
Practice Address - Phone:951-973-7290
Practice Address - Fax:951-973-7299
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40801208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A408010Medicare ID - Type Unspecified