Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | A50822 | CA |
Y | 207RP1001X | Pulmonary Disease | A50822 | CA |
NPI | 1083711014 |
---|---|
Provider Name | Fady Kadifa |
First Address | Laguna Niguel, CA 92607-7630 |
Second Address | Laguna Hills, CA 92653-3651 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 20/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A508220 | (05) | CA |
E27040 | (02) | CA |
P00229594 | MEDICARE RAILROAD (01) |