Provider Demographics
NPI:1477797124
Name:ABDULHAI, FADEL (DO)
Entity Type:Individual
Prefix:DR
First Name:FADEL
Middle Name:
Last Name:ABDULHAI
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 1:885 PATRIOT DR STE F
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-3353
Mailing Address - Country:US
Mailing Address - Phone:805-334-1371
Mailing Address - Fax:805-532-2844
Practice Address - Street 1:885 PATRIOT DR STE F
Practice Address - Street 2:
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-3353
Practice Address - Country:US
Practice Address - Phone:805-334-1371
Practice Address - Fax:805-532-2844
Is Sole Proprietor?:No
Enumeration Date:2009-04-25
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A 11553207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB204132Medicare PIN