Organization
W. AL-FADLY, M.D., INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WALEED S AL-FADLY M.D. (PRESIDENT)
(310) 324-1183
Entity
Organization
Contact information
Practice address
16000 S VERMONT AVE, GARDENA, CA 90247-4552
(310) 324-1183
(310) 324-4358
Mailing address
16000 S VERMONT AVE, GARDENA, CA 90247-4552
(310) 324-1183
(310) 324-4358
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
A20545
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A205453
—
CA
Enumeration date
07/27/2012
Last updated
07/27/2012
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