Provider Demographics
NPI:1467184614
Name:FADDA MD INC A P C
Entity Type:Organization
Organization Name:FADDA MD INC A P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ABDALLA
Authorized Official - Middle Name:
Authorized Official - Last Name:FADDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-829-8451
Mailing Address - Street 1:154 W FOOTHILL BLVD STE A#342
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:415 W CARROLL AVE STE 100
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-4208
Practice Address - Country:US
Practice Address - Phone:626-914-5219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty