Provider Demographics
NPI:1295430528
Name:PATRICK M. JADALI DPM INC
Entity type:Organization
Organization Name:PATRICK M. JADALI DPM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:JADALI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:562-285-7372
Mailing Address - Street 1:24641 COLEFORD ST
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-3925
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24641 COLEFORD ST
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-3925
Practice Address - Country:US
Practice Address - Phone:949-333-9626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-04
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility