Provider Demographics
NPI:1477787034
Name:FADAVI, HAMID R (DO)
Entity Type:Individual
Prefix:DR
First Name:HAMID
Middle Name:R
Last Name:FADAVI
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:26932 OSO PKWY
Mailing Address - Street 2:SUITE 275
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-5815
Mailing Address - Country:US
Mailing Address - Phone:949-916-8100
Mailing Address - Fax:949-916-8555
Practice Address - Street 1:26932 OSO PKWY
Practice Address - Street 2:SUITE 275
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-5815
Practice Address - Country:US
Practice Address - Phone:949-916-8100
Practice Address - Fax:949-916-8555
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-12
Last Update Date:2014-02-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AL1080 DO2081P2900X
CA20A11189208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CB207387OtherPTAN