Provider Demographics
NPI:1851443675
Name:ISSAC HADDAD M.D., INC
Entity Type:Organization
Organization Name:ISSAC HADDAD M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ISSAC
Authorized Official - Middle Name:M
Authorized Official - Last Name:HADDAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-296-6762
Mailing Address - Street 1:1446 N HOLLISTON AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-2546
Mailing Address - Country:US
Mailing Address - Phone:626-296-6762
Mailing Address - Fax:626-296-6762
Practice Address - Street 1:2990 E COLORADO BLVD
Practice Address - Street 2:105C
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-4463
Practice Address - Country:US
Practice Address - Phone:626-793-3700
Practice Address - Fax:626-793-3702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90074208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty