Provider Demographics
NPI:1275974552
Name:HADDAD, FADI (DO)
Entity Type:Individual
Prefix:DR
First Name:FADI
Middle Name:
Last Name:HADDAD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 WALNUT DR
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2047
Mailing Address - Country:US
Mailing Address - Phone:562-883-8804
Mailing Address - Fax:805-830-0491
Practice Address - Street 1:147 N BRENT ST
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2854
Practice Address - Country:US
Practice Address - Phone:562-883-8804
Practice Address - Fax:805-830-0491
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-15
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A15567207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology