Provider Demographics
NPI:1275666778
Name:EGGERDING, FAYE ADELE (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:FAYE
Middle Name:ADELE
Last Name:EGGERDING
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 N EL MOLINO AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1830
Mailing Address - Country:US
Mailing Address - Phone:626-795-4343
Mailing Address - Fax:626-795-5774
Practice Address - Street 1:99 N EL MOLINO AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1830
Practice Address - Country:US
Practice Address - Phone:626-795-4343
Practice Address - Fax:626-795-5774
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG38233291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACLF11613OtherCA LAB ID NUMBER