Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E3831 | CA |
Y | 222Z00000X | Podiatrist | E3831 | CA |
NPI | 1033310982 |
---|---|
Provider Name | Dr. Imad Ibrahim Haddad |
First Address | Chatsworth, CA 91311-3030 |
Second Address | Chatsworth, CA 91311-3030 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000E38311 | (05) | CA |