Individual
TAD FENNAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
1300 W 6TH ST, SUITE 2, SAN PEDRO, CA 90732-3531
(310) 831-0728
(310) 831-8564
Mailing address
1300 W 6TH ST, SUITE 2, SAN PEDRO, CA 90732-3531
(310) 831-0728
(310) 831-8564
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
E4107
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000E41070
—
CA
Enumeration date
07/07/2006
Last updated
10/15/2008
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