Provider Demographics
NPI:1588847024
Name:MONEIM A FADALI MD
Entity Type:Organization
Organization Name:MONEIM A FADALI MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:MONEIM
Authorized Official - Middle Name:A
Authorized Official - Last Name:FADALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-413-5472
Mailing Address - Street 1:2586 ABERDEEN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027
Mailing Address - Country:US
Mailing Address - Phone:213-413-5472
Mailing Address - Fax:323-664-6782
Practice Address - Street 1:2105 BEVERLY BL
Practice Address - Street 2:#225
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057
Practice Address - Country:US
Practice Address - Phone:213-413-5472
Practice Address - Fax:323-664-6782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29521208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A295210Medicaid
CAW4475Medicare PIN
CA00A295210Medicaid