Provider Demographics
NPI:1013940543
Name:TAWADROUS, FOUAD D (MD)
Entity Type:Individual
Prefix:
First Name:FOUAD
Middle Name:D
Last Name:TAWADROUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1148 SAN BERNARDINO RD #301
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786
Mailing Address - Country:US
Mailing Address - Phone:909-981-1053
Mailing Address - Fax:909-981-1334
Practice Address - Street 1:1148 SAN BERNARDINO RD #301
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786
Practice Address - Country:US
Practice Address - Phone:909-981-1053
Practice Address - Fax:909-981-1334
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24546173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A257060Medicaid
CA00A257060Medicare ID - Type UnspecifiedMEDICARE
CA00A257060Medicaid