Provider Demographics
NPI:1457345944
Name:RADU-RADULESCU, FELICIA (MD)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:RADU-RADULESCU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 TUMBLEWEED CT
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-6876
Mailing Address - Country:US
Mailing Address - Phone:408-839-0685
Mailing Address - Fax:
Practice Address - Street 1:429 LLEWELLYN AVE
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-1948
Practice Address - Country:US
Practice Address - Phone:408-364-1616
Practice Address - Fax:408-378-6775
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81710174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA800076144Medicare UPIN