Provider Demographics
NPI:1952490492
Name:FAYAD, JOSE N (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:N
Last Name:FAYAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOSE
Other - Middle Name:N
Other - Last Name:FAYAD MATTAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2470
Mailing Address - Street 2:HOUSE EAR CLINIC
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92593
Mailing Address - Country:US
Mailing Address - Phone:213-483-9930
Mailing Address - Fax:213-483-0905
Practice Address - Street 1:2100 W THIRD ST
Practice Address - Street 2:STE III HOUSE EAR CLINIC
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057
Practice Address - Country:US
Practice Address - Phone:213-483-9930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2008-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53247207Y00000X, 207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H01365Medicare UPIN
WA53247AMedicare PIN
A53247Medicare PIN