Provider Demographics
NPI:1619972247
Name:FADDA, GEORGE Z (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:Z
Last Name:FADDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4225 EXECUTIVE SQ STE 450
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-8411
Mailing Address - Country:US
Mailing Address - Phone:858-810-0000
Mailing Address - Fax:858-268-1911
Practice Address - Street 1:8851 CENTER DR
Practice Address - Street 2:STE 505
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3017
Practice Address - Country:US
Practice Address - Phone:619-461-3880
Practice Address - Fax:619-461-3895
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA44918207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A449180Medicaid
CAWA44918DOtherSO. CALIFORNIA PTAN
CACA122838OtherNO. CALIFORNIA PTAN
CACA122838OtherNO. CALIFORNIA PTAN