Provider Demographics
NPI:1720474281
Name:JAWAD, SADEED (MD)
Entity Type:Individual
Prefix:
First Name:SADEED
Middle Name:
Last Name:JAWAD
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 1:2347 DAYBREAK DR
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-1740
Mailing Address - Country:US
Mailing Address - Phone:978-578-9104
Mailing Address - Fax:916-581-8729
Practice Address - Street 1:2347 DAYBREAK DR
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-1740
Practice Address - Country:US
Practice Address - Phone:978-578-9104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-11
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA607790462084P0800X
CAA1632962084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1720474281Medicaid