Provider Demographics
NPI:1649275637
Name:HADDAD, NAZIH M (MD)
Entity type:Individual
Prefix:
First Name:NAZIH
Middle Name:M
Last Name:HADDAD
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 1:400 NEWPORT CENTER DRIVE
Mailing Address - Street 2:704
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660
Mailing Address - Country:US
Mailing Address - Phone:949-720-0505
Mailing Address - Fax:949-720-0534
Practice Address - Street 1:400 NEWPORT CENTER DRIVE
Practice Address - Street 2:704
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:949-720-0505
Practice Address - Fax:949-720-0534
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31234207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA61876Medicare UPIN