Provider Demographics
NPI:1811239536
Name:HAMID FADAVI DO INC
Entity Type:Organization
Organization Name:HAMID FADAVI DO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERSIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAMID
Authorized Official - Middle Name:
Authorized Official - Last Name:FADAVI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:949-916-8100
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-20
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A11189208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HF034AOtherPTAN